Fever and malaise associated with a painful papule on the ankle
Jennifer McQuade and Jennifer Clay Cather, MD
A 29-year-old woman with no significant past medical history presented with malaise, fever, headache, inguinal lymphadenopathy, and a painful lesion on her ankle (Figures 1 and 2). Other pertinent findings on cutaneous examination included faint blanching 2- to 3-mm macules on her trunk. There were no oral lesions and no signs of embolic phenomena. One week prior to presentation she had returned from a South African safari. All appropriate immunizations and prophylactic medications (i.e., antimalarial prophylaxis) were obtained before her trip.
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