A 25 year-old female with a past medical history of well controlled eczema presented to her primary care physician with a one week history of a painful “bubbles” localized to her right antecubital fossa as seen in Figure 1. She noted that the new rash appeared to form overnight, was extremely painful, and would occasionally drain a clear liquid after scratching. It did not respond to her usual over-the-counter regimen of moisturizers prompting her to be evaluated. She had subjective fevers and malaise but denied oral or genital ulcers, vaginal discharge, dysuria, ocular irritation, visual disturbances, and upper respiratory or gastrointestinal symptoms. Review of systems was otherwise unremarkable.
She had no other known medical problems, allergies, and denied drug and alcohol use. She denied any recent travel, sick contacts, pets, or OTC medications/creams. She was sexually active in a monogamous relationship for over a year.