Photo Quiz Question – Q.003

Photo Quiz Question – Q.003 – July 1, 2011

31-year-old white male, circa 1951, missionary to Nigeria

Illness started with fever and aching for 2-3 days, followed by development of blistering rash.  Above image depicts rash a week into the illness.

What does the above image depict?  Is there any treatment?  Should the patient be isolated?

To be honest, submit your response in the box below before turning to the answer.

 Photo courtesy of Wikimedia Commons

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About Cynthia J. Koelker, MD

CYNTHIA J KOELKER , MD is a board-certified family physician with over twenty years of clinical experience. A member of American Mensa, Dr. Koelker holds degrees in biology, humanities, medicine, and music from M.I.T., Case Western Reserve University School of Medicine, and the University of Akron. She served in the National Health Service Corps to finance her medical education.
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13 Responses to Photo Quiz Question – Q.003

  1. Rex says:

    My guess is small pox.

  2. Elizabeth C B says:


  3. Ken says:

    No clue but I’ll be a wimp and go with the consensus of smallpox

  4. Jim H. says:

    Have not heard the answer to this one yet..???

  5. Brian says:

    I believe possibly shingles, yes patient should be isolated, use antiviral meds, maybe calamine, too.

  6. Brian R says:

    I’m definitely not a doctor nor even close. I’m going to guess shingles.

  7. Chris MD says:

    I vote smallpox in a nutritionally replete individual.

  8. SteadySteve says:

    I agree with KD. But is there not sometimes a respiratory symptom along with the infection? Agree patient is contagious and needs to be isolated.

  9. Rich S. says:

    Not much information, but I do not feel it is smallpox. The pustules are not all in the same state as smallpox would be. I might be led down the track of chickenpox. But still not sure… Chickenpox usually hit the chest first and radiates outward to the arms legs and hands and feet. I would have to guess based on the limited info that it is poison ivy or something like it. I know he had a fever, but if he has enough poison ivy on him it would be possible from what I have seen that he could run a low grade fever. Also, another reason I don’t think it is smallpox even though smallpox runs the opposite of chickenpox, in that his face arms and outer perimeter would get the pus sacks first which his face has. But the rest of his body has almost nothing as far as I can see in the photo. So I say either one of the plant irritations like poison ivy or oak. Or it might be shingles, too, but my clinical knowledge is limited on that one.


  10. KF says:

    Smallpox. The scabs will eventually fall off leaving marks on the skin that will become pitted scars. The patient is contagious to others until all of the scabs have fallen off.

    • KF says:

      Smallpox presents as an acute viral illness with 2-4 day of fever and myalgias with rash predominately on face and extremities. The person is CONTAGIOUS at the onset of this rash. Respiratory (droplet) and Contact (person to person) Isolation is warranted.
      Exposed materials, clothing and linens should not be burned or boiled, due to potential spread by droplets or aerosolization!
      Skin lesions progress from macules to papules to vesicles
      quickly. The rash scabs over in 1 to 2 weeks.

      The average incubation period is 12 days. (but ranges 7to17 days)

  11. Jim H says:

    Looks like chicken pox–have been told it is much more severe in adults..I had chicken pox as a youngster and cannot remember it being so bad.

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