case_images: PMC11785457_01
case_images: An evanescent, non-pruritic macular rash over the patient's right distal hand, visible during febrile episodes only (arrow).
case_images: cureus-0017-00000076723-i01.jpg
case_images: PMC11785457_01_cureus-0017-00000076723-i01.jpg
case_images: FIG1
case_images: However, it is associated with an evanescent, non-pruritic macular rash, mainly over the patient's distal hands (Figure 1).
case_images: Diffuse erythematous maculopapular, burning, non-evanescent, and itchy rash on the patient's right hand.
case_images: cureus-0017-00000076723-i02.jpg
case_images: PMC11785457_01_cureus-0017-00000076723-i02.jpg
case_images: FIG2
case_images: The patient subsequently presented one week post-discharge with diffuse erythematous maculopapular, burning, non-evanescent, and itchy rash involving her entire body (Figures 2, 3).
case_images: Diffuse erythematous maculopapular, burning, non-evanescent, and itchy rash on the patient's left hand.
case_images: cureus-0017-00000076723-i03.jpg
case_images: PMC11785457_01_cureus-0017-00000076723-i03.jpg
case_images: FIG3
case_images: The patient subsequently presented one week post-discharge with diffuse erythematous maculopapular, burning, non-evanescent, and itchy rash involving her entire body (Figures 2, 3).
case_images: Microscopic examination of the skin biopsy showing fused rete ridges and mild spongiosis, with the superficial dermis having perivascular lymphocytic infiltrates (green arrow), along with rare neutrophils. The surrounding stroma has extravasated red blood cells (orange arrow) and a few karyorrhectic debris. The deeper dermis is within normal limits and shows normal-appearing adnexal structures. No neutrophilic collections. No epidermal necrosis or atypia. Consistent with urticarial vasculitis.
case_images: cureus-0017-00000076723-i04.jpg
case_images: PMC11785457_01_cureus-0017-00000076723-i04.jpg
case_images: FIG4
case_images: A dermatology opinion was sought, and a skin biopsy was ordered, which revealed urticarial vasculitis (UV) (Figure 4).
case_images: Rashes resolving with peeling and collarette of scales. Plantar and medial aspects of the foot.
case_images: cureus-0017-00000076723-i05.jpg
case_images: PMC11785457_01_cureus-0017-00000076723-i05.jpg
case_images: FIG5
case_images: The rashes started resolving with peeling and collarette of scales (Figures 5, 6).
case_images: Rashes resolving with peeling and collarette of scales. Dorsal aspect of the foot.
case_images: cureus-0017-00000076723-i06.jpg
case_images: PMC11785457_01_cureus-0017-00000076723-i06.jpg
case_images: FIG6
case_images: The rashes started resolving with peeling and collarette of scales (Figures 5, 6).