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.
A bedside ultrasound image of the rash was obtained (figure 2).
Question What is the most likely cause of the patient’s rash?
A. Herpes zoster
C. Necrotising fasciitis
D. Bullous pemphigoid
- 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.