Case 40-1989: A 40-Year-Old Man with Headache, Fever, Rash, and Thrombocytopenia after a Caribbean Trip

Presentation of Case A 40-year-old man was admitted to the hospital because of fever, headache, and a rash. The patient was well until two days earlier, near the end of a two-week visit to St. Thomas in the Virgin Islands, when he awoke with a pruritic, erythematous rash over the proximal portions of the arms and legs that soon spread to the trunk, sparing the face, palms, and soles. That evening he returned to Boston on schedule in an airliner and began to experience pain around his waist, a bitemporal headache with mild photophobia, and fever and chilliness while en . . .