Diffuse, pruritic, papular rash.

Volume 88, Number 9 www.aafp.org/afp American Family Physician 605 A 34-year-old man presented with a pruritic, erythematous, papular rash that appeared two days earlier. The rash started on his trunk and back, then progressed to his arms and the proximal portion of his legs. He did not have pain, burning, or a tingling sensation. He did not have a fever or other systemic symptoms, and the review of systems was otherwise unremarkable. He did not have sick contacts and was not using any new medications, soaps, lotions, or detergents. He ate a salad with shiitake mushrooms, pine nuts, and organic corn the day his symptoms started. Physical examination revealed diffuse, linear papules over the extremities and trunk (see accompanying figure). There was no tenderness, induration, warmth, scaling, or exudate.