A 35 year old male, while on vacation in the Dominican Republic, developed unilateral plantar blisters, bilateral palmar papules and induration on his back. The following day he became sytemically ill with malaise and fever. He attributed the symptoms to an insect bite which occurred while jogging on the beach. Blood indices showed a neutrophilia and a marked eosinophilia. He failed to respond to treatment with broad spectrum intravenoud antibiotics, antivirals and high potency topical steroids. Further organ involvement and general deterioration necessitated hospitalization. Over the subsequent 3 weeks he gradually imoproved on high dose intravenous steroids.
indurated discrete and confluent red, edematous, papules and plaques with overlying scale and crusts