How a painful rash ended in urgent chemo

A patient presents with a one-week history of rash, but systemic work-up and imaging reveal something more urgent

Fiona, a 65-year-old retired woman, who is generally very healthy, presents with a one-week history of a generalised painful rash.

It initially affected her vagina then progressed to involve her chest and abdomen.

She is otherwise well and has no systemic symptoms.

Fiona has a past history of mild asthma and is up-to-date with routine vaccinations, including shingles vaccine, which she received one year ago.

Examination

Vital signs are within normal range.

Fiona has a widespread rash affecting the chest, back and abdomen.

The rash is clinically consistent with acute varicella.

There are also tender vesicles on the labia, and exudated ulcerated lesions in the perianal region and natal cleft.

Systems examination is otherwise unremarkable.

Figure 1. Papules and vesicles on the back, Figure 2. Chest X-ray showing left seventh rib</body></html>

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