A 45-Year-Old Teacher With a Groin Rash That Is Spreading

Tiffany Kwok, BHSc; Benjamin Barankin, MD, FRCPC


October 21, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us


A 45-year-old woman presents to the emergency department (ED) with a 2-day history of an acute-onset, mildly pruritic rash. The rash started in her axillae and groin and has since progressed to the rest of her body. She then developed a fever.

She was diagnosed with pneumonia 4 days ago and has been taking azithromycin since that time. She was previously in good health, and her past medical history and family history are negative for psoriasis, arthritis, and other significant medical conditions. She has no known history of drug allergies. She does not smoke and drinks an average of two glasses of wine each week. She is a teacher, and she has two young children at home.