Case records of the Massachusetts General Hospital. Case 11-2015. A 28-year-old woman with headache, fever, and a rash.

New England Journal of Medicine 372(15):1454 (2015) PMID 25853750

A 28-year-old woman was seen in the emergency department of this hospital because of the acute onset of headache, fever, rash, and myalgias. On examination, she had petechiae on the chest, abdomen, and thighs and a purpuric lesion on the right shoulder. Presentation of Case Dr. Anant Mandawat (Medicine): A 28-year-old woman was seen in the emergency department of this hospital because of headache, fever, and a rash. The patient had been well until the morning of the day of admission, when she awoke with a severe generalized headache. The headache worsened with movement, was not relieved by acetaminophen or ibuprofen, and was accompanied by nausea and one episode of nonbloody, nonbilious emesis. The patient returned to sleep and awoke again several hours later with diffuse myalgias; her temperature was 37.7°C. At that time, she also noted a rash on her abdomen, . . .

DOI: 10.1056/NEJMcpc1415165