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Man with leg rash
  1. Michael Huynh Hwang,
  2. Ziyad Khesbak,
  3. Yiju Teresa Liu
  1. Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, USA
  1. Correspondence to Dr Michael Huynh Hwang; mihhwang1{at}


Clinical introduction A 51-year-old male presented to the ED with a rash to his left thigh (figure 1) with erythema, swelling and pain. He endorsed paraesthesias, pruritus, fevers, vomiting and diarrhoea. Initial vitals were unremarkable. He was well appearing with an 8×8 cm violaceous patch on his left medial thigh with vesicles, surrounding erythema and induration with a second, smaller lesion on the right thigh. Both rashes were extremely tender.

Figure 1

Erythematosus and vesicular rash in bilateral legs.

A bedside ultrasound image of the rash was obtained (figure 2).

Figure 2

Bedside ultrasound of rash.

Question What is the most likely cause of the patient’s rash?

A. Herpes zoster

B. Cellulitis

C. Necrotising fasciitis

D. Bullous pemphigoid

  • ultrasound
  • musculo-skeletal
  • soft tissue infection

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  • Contributors YTL planned the study and performed critical revisions.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.