A 25-year-old woman complains of low-grade fever, malaise, and sore throat. After this prodromal phase, a rash of discrete erythematous macules begins on her arms and progresses to form painful hemorrhagic pustules on her arms and hands. She is noted to have pharyngeal erythema.
What is the most likely cause of her rash?
A. Cat scratch diseaseGonococcal infection is sexually transmitted through mucosal invasion, either oral or genital. Disseminated gonococcal infection commonly causes tenosynovitis, septic arthritis, and hepatitis. Sparse, 1- to 5-mm erythematous macules occur within 24 to 48 hours, usually affecting the arms more than the legs. Cat-scratch disease is associated with a history of cat contact in 90% of cases and presents with tender lymphadenopathy. Bedbug (Cimex lectularius) bites commonly occur in rows of two or three lesions and are pruritic; they do not disseminate. Shingles lesions occur in dermatomal distribution and are vesicular. “Skin popping” is the technique of injecting illicit drugs subcutaneously. This practice can cause localized abscesses, cellulitis, or even tetanus, but would not cause this woman’s pharyngitis or her disseminated discrete pustules.