A 46-year-old woman with hypothyroidism and prior substance use disorder presented to the emergency department with a 1-week history of left eye blurry vision and floaters.
Four weeks before presentation, she developed a pruritic rash that began on her thighs and spread to involve the trunk and scalp before further extending distally (Figure 1). Around the time of the rash’s onset, she developed diffuse arthralgias and patchy hair loss. The patient also endorsed bilateral periorbital pruritus, epiphora and photophobia. In the past 2 weeks, she also experienced morning headaches alleviated by