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A 27-year-old male was seen for a two-month history of fever, lethargy, polyarticular arthralgias, and eruptions over the palms and the soles. Systemic symptoms, including diarrhea, dysuria, headaches, or gastrointestinal symptoms were unnoticeable. The temperature was 37.9 ◦C. Skin examination showed erythemas on the palms and soles. On the top of these lesions, Biett’s collarette was presented typically to be a central clearing and a rim of collarette scales (Fig. 1). No lesions were observed on other parts of the skin or mucosa. Blood tests revealed a raised white blood cell count of 8400/ L and elevated C-reactive protein level of 85 mg/L. Rheumatoid factor was slightly elevated at 18 IU/mL, tests for double-stranded DNA and extractable nuclear antibodies were negative. Chest radiograph was also normal. Conjunctival, cardiovascular, and genital evaluations were unremarkable. A rapid plasma reagin (RPR) test was negative, but became positive when diluted at

Arthralgia and scaly rashes over the palms and the soles