1. Erythematous lesions, suprapubic pain, and myalgia
A 32-year-old previously healthy woman presents to the emergency department with skin lesions, suprapubic pain, and generalized myalgia of 1 week’s duration. Trimethoprim-sulfamethoxazole for a presumed urinary tract infection is prescribed, and the patient is discharged. The symptoms persist; she is hospitalized 2 days later.
The patient denies diarrhea, dysuria, vaginal discharge, chills, or rigors. Her last menstrual period was 10 days earlier. Temperature is 37.4oC (99.4oF); other vital signs are normal.
Mild suprapubic tenderness is noted; there are no masses or signs of peritonitis. Several tender maculopapular erythematous lesions with several vesicles and scabs are scattered over the extremities and trunk (A). The right first metacarpophalangeal and right elbow joints are erythematous, tender, and slightly swollen (B).
What condition is the likely cause of this woman’s symptoms?
(Answer on next page.)