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40 yof with no remarkable PMHx. Presents to clinic 2 days s/p being awoken by a feeling like her thumb was on fire. Stayed 2 nights in a vacation rental house for 2 days in Utah. 24 hours after the episode PT reports thumb lesions turning into thick black vesicular weeping sores. Accompanied with 10+ macular erythemaypus lesions dispersed across her UE’s. (See pic 2 and 3)

PT describes thumb lesion as a burning pain. ROM is limited by swelling. UE lesions are pruritic with serious discharge.