A 32-Year-Old with Fever, Cough, Arthralgia, and Photophobia

A 32-year-old immunocompetent male presents with fever, cough, arthralgia, and photophobia for a few days. On examination, he had a temperature of 100°F (37.8°C) and conjunctival injection. There was a widespread erythematous macular rash on his wrist.

When asked about travel, the patient mentioned that he recently visited his family in the Dominican Republic. During his travels, he drank local water and sustained a few mosquito bites. His symptoms began approximately 4 days after his return home.

View the photo taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.