A 43 year old Indonesian man with no significant medical history presented with acute onset of pain and redness of his left eye. It was accompanied by sore throat, low grade fever, arthralgias, and myalgias. He had been a lifelong non-smoker, and denied alcohol intake or illicit drug use. He was married with no history of extramarital sexual contact. There was no history of exposure to animals or birds or recent travel abroad.

Examination revealed a temperature of 102.2°F (39°C), congested throat without any exudate, and a few aphthous ulcers on the buccal mucosa. The left eye was red but the pupils were equal and reactive to light and accommodation with intact but painful extraocular movements.

Complete blood count, serum chemistries, liver function tests, throat swab, and blood cultures remained negative. A chest radiograph was also normal. Erythrocyte sedimentation rate was 26 mm/hour.

Twenty four hours later the patient developed a circumscribed maculopapular rash around the insertion site of the intravenous cannula, which gradually progressed to vesicular eruption. He also complained of pain in his oral ulcers and blurring of vision.

QUESTIONS

1. What is the most likely diagnosis?

2. What is the rash around the intravenous cannula site and what is the pathophysiology for this phenomenon?