Presenter: Leslie Marshall, D.O.

Dermatology Program: Northeast Regional Medical Center

CHIEF COMPLAINT: “itchy rash”

CLINICAL HISTORY: A previously healthy, non-pregnant 22-year-old Hispanic female presented with a 5-day history of a pruritic eruption on her dorsal right hand, upper arms, and back. She had returned to the United States 4 days prior after a 2-week trip to Santa Anna, El Salvador. Her symptoms began one week after her arrival to El Salvador with neck swelling and general malaise. One day before returning home (day 7 of illness), she developed tenderness and swelling surrounding a mosquito bite on her right ankle followed by a rash on her arms, back, and thighs. Accompanying symptoms included arthralgias in her hands, a low-grade fever, headache, and paresthesias. She was prescribed a prednisone taper from the ER physician, which was not helpful. She reported being bitten several times by mosquitos while in El Salvador.