Issue: 2017 > January > photo quiz

Fever and painful skin lesions after a holiday in Gambia

H.R. Bouma, W.D. Kloppenburg
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A 19-year-old man visited our emergency department because of high fever, headache and painful skin lesions one day after returning from a two-week holiday in Gambia. One week ago, a small itching bug-bite-like lesion appeared on his right lower leg, which gradually increased in size. At presentation to our emergency department, he had an ill appearance and a body temperature of 39.8°C. Two large erythematous lesions with diffuse borders, a central boil-like furuncle and oedema formation were seen on his right lower leg (figure 1). The patient had a painful, mobile, weak-elastic, round lump, 2 cm in diameter, in his right groin. Laboratory analysis revealed leukocytosis (15.3 x 109/l, of which 13.4 x 109/l neutrophils) and an increased C-reactive protein (51 mg/l). The remainder of the examination did not reveal any relevant abnormalities.