Vesiculobullous and desquamating skin disorders Quiz: Ace Your Exams

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A 14-year-old boy living in the Southwest United States is brought to the office by his parent because of a nonpruritic rash on his hands for the past two days. He has also had mild shortness of breath, dry cough, and malaise since last week. He has no prior medical conditions and does not take any medication. Vaccinations are up-to-date, and he has not traveled recently. Temperature is 37.7°C (99.9°F), pulse is 92/min, respirations are 22/min, and blood pressure is 115/80 mmHg. Examination of the hands reveals the following:  

A close-up view of two hands showing multiple circular red rashes on the backs of fingers and palms, against a background of gray fabric.
Reproduced from Flickr  
Lung auscultation reveals bilateral coarse crackles. Chest x-ray shows patchy, non-segmental bilateral opacities. Which of the following is the most likely cause of this patient’s skin lesions?  

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