Daiki Yokokawa, MD, Kiyoshi Shikino, MD, PhD, Sogai Daichi, MD, Yuta Hirose, MD and Masatomi Ikusaka, MD, PhD
August 1, 2017
A 48-year-old Japanese woman with past medical history of eosinophilic gastroenteritis presented with a 4-month history of recurrent episodes of high-grade fever with abdominal pain and rash that occurred monthly with her menstrual period. The episodes were self-limited, lasting 1–2 days. She was asymptomatic between the episodes. The rash was non-tender; diffusely edematous and erythematous; and located on her limbs, palms, soles, and trunk, resembling erysipelas (Figs. 1-2). The erythema disappeared after applying finger pressure to the palm (Fig. 2, arrowhead). She had no significant family history. Her only medications were Rebamipide, Polycarbophil calcium, Hangeshashinto (herbal medicine), and acetaminophen for pain. She denied smoking and alcohol use. Laboratory tests showed leukocytosis (29,800/μL) with predominant neutrophilia (95%) [A1] and no eosinophilia or evidence of organ damage. Anti-nuclear antigen (ANA) test was negative.
What is the most likely cause of the patient's fever and skin lesion?
A. Cellulitis
B. Familial Mediterranean fever (FMF)
C. Scarlet Fever
D. Systemic Lupus Erythematosus (SLE)
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References
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Author Information:
Daiki Yokokawa, MD, Sogai Daichi, MD, and Yuta Hirose, MD are a Clinical Fellow of the Department of General Medicine at Chiba University Hospital in Japan.
Kiyoshi Shikino, MD, PhD is Project Assistant Professor of the Department of General Medicine at Chiba University Hospital in Japan
Masatomi Ikusaka, MD, PhD is a Professor of the Department of General Medicine at Chiba University Hospital in Japan.
Conflict of Interest: The authors declare that they do not have any conflicts of interest.