A previously healthy 36-year-old man was presented with a 1-month history of fever and pain in both shoulders and knees. The man also experienced sore throat before the onset of fever. Examination Laboratory results were as follows: WBC count of 13800 per cubic millimeter 85% neutrophils C-reactive protein level: 26 mg /dl Antistreptolysin O titer of 1478 IU per milliliter; (reference value, <241) Echocardiography revealed mild aortic regurgitation. His symptoms receded after administration of a nonsteroidal anti-inflammatory drug.
However, one week later, painless, nonpruritic, red annular macules appeared on the upper limbs and abdomen (indicated in the first image). The rash migrated within hours and then faded over the course of a few days while new lesions appeared. Biopsy Skin biopsy (H & E staining) was performed. Biopsy revealed perivascular infiltration of lymphocytes and…
