A 50-year-old heterosexual man presented to the emergency department for evaluation of a diffuse rash that started 10 weeks prior to hospital admission. He reported that the lesions began as small (0.3 cm), pink papules on his upper extremities, which progressed into large (3 cm), red, annular, plaque-like lesions that developed a thin scale within several days of onset. Subsequently, the lesions spread to his scalp, face, trunk, genitals, and lower extremities. He reported subjective fevers, chills, occasional drenching night sweats, and a 10-lb weight loss. Simultaneous with the onset of the skin lesions, he had an intermittent nonproductive cough, without dyspnea. Six weeks prior to presentation, he described the onset of sinus congestion with occasional epistaxis and left eye conjunctivitis, at which time he received a course of antibiotics. He denied any significant medical history. He also denied tobacco use, animal exposures, or recent travel. He worked as a cartographer in Colorado.