ABSTRACT
A 22-year-old man presented to the emergency department with right leg swelling. He had returned 4 days earlier from a 3-week walking holiday in Ireland. Over the course of several days, his right ankle had become progressively more swollen and was now developing a blistering rash. The patient complained of severe pain and was now unable to weight bear. He was concerned that the swelling was extending to his right knee. While waiting in the emergency department, he noticed a rash developing over his arms and left leg. He had not taken any new medications, used any topical treatments on his leg or changed his bath products or washing detergent. The patient thought he had sustained an insect bite during his holiday to Ireland. His past medical history included depression, for which he took 50 mg sertraline OD. He was a non-smoker, denied any recreational drug use and usually drank minimal alcohol, but while in Ireland had consumed 20 units daily.
