Painful Nodular Lesions over the Hands.

Introduction A 27-year-old woman present with a 3-day history of painful lesions over her fi ngertips associated with a right wrist swelling, yellowish vaginal discharge and fever. Her past medical history was unremarkable. Physical examination revealed haemorrhagic pustules over the left thumb, left middle fi nger (Fig. 1), as well as tender linear erythematous patches overlying the lateral extensor tendons of the right wrist and fl exor tendons of the right elbow (Fig. 2). A speculum examination showed copious amounts of yellowish discharge. The cardiovascular examination was essentially normal with no splinter haemorrhages or clubbing seen. What is the diagnosis? A. Infective endocarditis B. Disseminated gonococcal infection C. Meningococcemia D. Rocky mountain spotted fever E. Hand, foot and mouth disease