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JAMA Clinical Challenge

Oral Ulcers and Targetoid Lesions on the Palms

Image of A, Shallow erosions with hemorrhagic crusts on the lips of a 22-year-old woman. B and C, Targetoid macules with dusky centers on the palms

Barry Ladizinski, MD
Kachiu C. Lee, MD, MPH

A 22-year-old woman presents with oral ulcers and a rash on her palms of 4 days' duration. She does not take any prescribed or over-the-counter medications. Review of systems is noncontributory, and she denies fevers, chills, shortness of breath, cough, and genital lesions. Vital signs are normal, and physical examination reveals shallow erosions with hemorrhagic crusts on the lips and widespread targetoid macules with dusky centers on the palms (Figure). The remainder of the examination is unremarkable.

See the full article for an explanation and discussion.

Author Affiliations: Dr Ladizinski (barryladizinski@gmail.com) is affiliated with the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. Dr Lee is affiliated with the Department of Dermatology, Brown University, Providence, Rhode Island.