Rash and elevated creatine kinase in a deployed soldier

Abstract

A 24-year-old active duty soldier was evacuated from Afghanistan to the United States after persistent upper respiratory tract infection. His course was complicated by an exfoliative rash, diffuse muscle aches, and elevated creatine kinase following trimethoprim–sulfamethoxazole exposure that persisted despite withdrawal of the medication. Dermatomyositis was strongly considered, but the patient had a negative muscle biopsy and had positive serologies for acute Epstein–Barr virus infection. We present a case of acute Epstein–Barr virus infection and possible trimethoprim– sulfamethoxazole reaction mimicking dermatomyositis.