A Man with Fever and Rash

He had a history of ulcerative colitis, and the current illness began with pharyngitis. Over several weeks, additional signs and symptoms emerged, including polyarthralgia, liver injury, orchitis, proteinuria, and hematuria. Although test results indicated potential malaria or Epstein–Barr virus (EBV) infection, his clinical picture did not fit either of these diseases. Eventually, skin biopsy with direct immunofluorescence staining (Figure 1) led the treating physicians to the correct diagnosis.