An Anxious Hiker With Recurring Annular Rash and Sleep Loss

Dirk M. Elston, MD


January 26, 2022

Physical Examination and Workup

Her vital signs are stable, including a temperature of 97 °F (36.1 °C), a blood pressure of 120/70 mm Hg, and a pulse of 70 beats/min. She has a history of hypothyroidism and takes a stable dose of thyroid hormone. She is not currently experiencing arthralgia or neurologic symptoms.

A complete examination is performed and reveals no additional lesions other than those shown in Figure 1.

Figure 1.

A review of systems is otherwise negative for sinus, dental, respiratory, joint, or other symptoms. Extensive laboratory testing is deemed unnecessary, given her presentation and history.


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