Man with leg rash

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Clinical introductionA 51-year-old male presented to the ED with a rash to his left thigh (figure 1) with erythema, swelling and pain. He endorsed paraesthesias, pruritus, fevers, vomiting and diarrhoea. Initial vitals were unremarkable. He was well appearing with an 8×8 cm violaceous patch on his left medial thigh with vesicles, surrounding erythema and induration with a second, smaller lesion on the right thigh. Both rashes were extremely tender.A bedside ultrasound image of the rash was obtained (figure 2).QuestionWhat is the most likely cause of the patient’s rash?A. Herpes zosterB. CellulitisC. Necrotising fasciitisD. Bullous pemphigoid

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