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Case Presentation. Middle aged hypertensive and asplenic man presented with a pruritic rash on his right buttock accompanied by flu-like symptoms. 1010, arthralgias, myalgias, some nausea, and general malaise, and decreased appetite.Reports walking through a wooded area on Martha\'s Vineyard, an island off the coast of Mass.PE shows a well nourished man with no significant findings other than an erythmatous oropharynx without exudate. .

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