Puzzling Papules: Uncovering the Etiology of a Rash in a Returning Traveler
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Publication Date
4-29-2026
Keywords
oregon, psvmc, psvmc gme, psvmc oaa
Disciplines
Medical Education
Abstract
Introduction: There are an estimated 1.8 billion people that travel internationally every year [1]. Approximately 22-64% of those acquire an infectious disease during or after returning home that is not endemic to their home country [1]. This is especially concerning in our current political climate and declining vaccination rates in the United States which places more patients at risk for preventable diseases [2]. These factors present a unique challenge in diagnosing and treating a symptomatic returning traveler. Case Description: A 25-year-old incompletely vaccinated male returned from Kenya after volunteering for 5-weeks in a rural hospital. He was in his usual state of health until two days prior to admission when he developed fever, malaise, throat pain and dry cough. He boarded the airplane from Kenya and arrived in Oregon the day prior to admission with worsening symptoms and a new rash on his back. Denied abdominal pain, nausea, vomiting, diarrhea. While in Kenya, he was in a patient facing role while volunteering at a local hospital but denied sick contacts or traveling companions. No exposure to contaminated food or water. No sexual contacts. Prior to his trip he received Doxycycline for malaria prophylaxis, Hepatitis A and oral typhoid vaccines. Upon review of vaccination records, he did not receive the MMR vaccine as a child due to an adverse reaction in a relative. In the ED, he was placed in airborne precautions with vital signs notable for a fever of 39.3C and tachycardia. Physical exam with diffuse maculopapular, non-pruritic rash over back that was starting to coalesce and spread to the trunk, face and arms; sparing palms and soles. Noted to also have subtle bilateral injected conjunctiva and ulcerated oral lesions over the buccal mucosa. Workup revealed leukopenia and mild transaminase elevation. Negative blood cultures. Limited infectious workup initiated which later resulted positive for Rubeola. The patient was treated supportively and discharged home in good condition. Discussion: Measles, one of the most contagious infectious diseases, affects approximately 10.3 million people worldwide [2]. While measles is considered “eliminated” in the United States, rates continue to rise. In 2025, there has been a total of 1356 cases of Measles in the United States with 34% above the age of 20 and 13% requiring hospitalization [3]. Outbreaks often stem from unvaccinated international travelers [2]. This case highlights the importance of collecting a thorough vaccination history in this population to streamline infectious workup and reduce healthcare costs. Furthermore, this case underscores the critical need for continued vaccination advocacy in primary care to prevent resurgence of measles and other similar communicable and vaccine preventable illnesses.
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Internal Medicine
