A 50-year-old woman presented to her family physician for a urinary tract infection (UTI) and an itchy rash. She said the rash had developed 2 years earlier and had gotten worse, with additional lesions emerging on her skin as time went on. She noted that other physicians had evaluated the rash but provided no clear diagnosis and had done no testing.
A physical exam revealed scattered erythematous papules with white centers on the patient’s trunk, arms, and legs (FIGURE 1). The patient’s medical history was significant for asthma, obstructive sleep apnea, obesity, gastroesophageal reflux disease, urinary incontinence, and depression. Her medications included montelukast, inhaled fluticasone, albuterol, tolterodine, omeprazole, and fluoxetine.
The patient was prescribed nitrofurantoin, 100 mg twice daily for 5 days, to treat her UTI, and a punch biopsy was performed on one of the patient’s lesions to determine the cause of the rash.
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