How a painful rash ended in urgent chemo

A patient presents with a one-week history of rash, but systemic work-up and imaging reveal something more urgent
Papules and vesicles on the back
Figure 1. Papules and vesicles on the back, Figure 2. Chest X-ray showing left seventh rib bony destruction and pleural thicyening and Figure 3. CT chest demonstrating a pathological fracture of the left seventh rib and a soft tissue mass.

Fiona, a 65-year-old retired woman, who is generally very healthy, presents with a one-week history of a generalised painful rash.

It initially affected her vagina then progressed to involve her chest and abdomen.

She is otherwise well and has no systemic symptoms.