Issue: 2018 > April > photo quiz

A patient with fever and skin lesions after vacation in South Africa

M.W.L. van Geffen, J.M. van Niekerk, D. Posthouwer
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A 61-year-old patient presented with fever to the emergency department. The fever started six days after she returned from a four-week vacation in South Africa and persisted throughout the day. She had been travelling from Cape Town, via Johannesburg to the northern border of Botswana. She had not taken any malaria prophylaxis nor had she had any vaccinations. During her vacation she had no symptoms. At the emergency department the patient complained of mild headache and localised myalgia in her lower back. Furthermore, she had a fever (38°C) and multiple skin lesions. There were no signs of lymphadenopathy. A vesicular (figure 1) and maculopapular rash was seen on both legs. One skin lesion presented with a central necrotic core (figure 2+3). The laboratory showed an elevated CRP (40 mg/l), the other laboratory results were unremarkable with normal haemoglobin, leukocytes and platelet count.