History: This 24-year old male patient was admitted with history of generalized skin rash, fever, multiple joint pain of about 2 months duration. Fever was high grade and sometimes associated with chills and rigors. Patient complained of joint pain involving all small as well as large joints on and off. Examination revealed generalized erythematous macular rash, ichthyotic skin over both legs, gross swelling of both hands involving the fingers as well and slight swelling of other joints as well as mild tenderness.