Kay is a 60-year-old retail assistant who presents with 10 days of a painful red rash on her forearms.

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<p>Kay is a 60-year-old retail assistant who presents with 10 days of a painful red rash on her forearms. She has associated fever, malaise and arthralgia.</p><p>This is most frustrating as she has only just recovered from a bout of influenza three weeks previously.</p><p>Kay is usually very well, with no past history of note, and takes no regular medications.</p><p>She used paracetamol for symptom control during her bout of flu.</p><p>On examination, she has a temperature of 38.5°C, with otherwise normal vital signs.</p><p>There are tender erythematous papules and nodules on both forearms, with no other dermatological findings of note.</p><p>Joint examination is unremarkable. Blood tests reveal an elevated CRP of 56 (normal &lt;5) and neutrophilia.</p><p>Autoimmune inflammatory markers are normal, as is urinalysis.</p><p>A biopsy of one of the lesions reveals dense dermal neutrophilic infiltrates.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.