Memory of an exotic holiday

Published: 18 July 2015
Author(s): Evelyne Franon, Patrick Manckoundia
Section: Internal Medicine Flashcard

A 66-year-old man with no particular medical history and back from a 10-day trip to South Africa, consulted for headache, myalgia, odynophagia and low-grade fever (38°), which had lasted for 3days. The clinical examination revealed several escharotic skin lesions on the anterior left groin (Fig. 1a) and right ankle (Fig. 1b), which had appeared the day before, without pain or itching. The lesions were surrounded by several erythematous papules. Biological tests showed leukopenia at 3400cells/mm3 (normal 4000–10,800) with neutropenia at 1300cells/mm3 (normal 1800–6800), and an increase in aspartate aminotransferase at 199IU/L (normal 17–59) and alanine aminotransferase at 185IU/L (normal 21–72).