An abdominal computed tomography scan showed no abnormalities. An acute hepatitis B infection was diagnosed [HBsAg positive, HBeAg positive, and presence of HBc immunoglobulin (Ig) M, and IgG antibodies]. Cytomegalovirus, Epstein Barr virus, hepatitis A, hepatitis

C, hepatitis E, and human immunodeficiency virus infections were excluded. A toxic drug reaction was considered unlikely, because mefloquine was already stopped for several months. In retrospect, all stored blood samples, taken at presentation and at several times of follow-up, were tested by quantitative real-time PCR NU7441 clinical trial for hepatitis B DNA and found positive, including the samples taken at the time of first presentation [hepatitis B virus (HBV) DNA viral load at presentation 4,450 copies/mL; the maximal viral load of 1.35 × 109 copies/mL was documented almost 4 months after presentation]. Additional analysis showed the genotype A of HBV. Reevaluation of his vaccination status revealed that this website he had never received hepatitis B vaccination, in contrast to our national guidelines for long-term

travelers. Two months later, his liver function tests normalized and after 4 months the patient became HBsAg negative. The skin lesions did not recur. An infection with HBV may lead to several hepatic complications including an acute hepatitis, which may be associated with a number of extrahepatic manifestations such as urticarial skin lesions and periorbital edema.5 The association is supposed to be commonly observed during the prodromal phase of the hepatitis

B infection, but is only anecdotically reported 4��8C in the ancient literature.5 The occurrence of these prodromal cutaneous manifestations of acute hepatitis B infection is ascribed to immune-mediated mechanisms6 and can be easily misinterpreted as a feature of allergic disease. Our case highlights the importance of considering an acute HBV infection in the differential diagnosis of recurrent urticaria, even when liver function tests are normal. P. J. v G. has received speaker’s fee from GlaxoSmithKline (GSK) and reimbursements from GSK and Sanofi Pasteur MSD for attending symposia. The other authors state that they have no conflicts of interest to declare. “
“A 26-year-old woman was affected with a maculopapular rash because of a jellyfish sting on her right leg while surfing in Indonesia. A locally-prepared liniment was applied on the affected skin. She presented with hyperpigmented linear tracks that she noted a few days later. A 26-year-old healthy, Dutch woman was admitted to the Institute for Tropical Diseases in Rotterdam with residual maculopapular rash on her right thigh and several hyperpigmented linear tracks on her right leg. Two weeks earlier, she had felt a stinging sensation on her right thigh while surfing in Indonesia. Back on shore, she noticed a painful maculopapular rash.