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Question category: Tropical medicine

A 27 year old female has just returned from fruit picking in California. She presents with fever, cough, malaise and a rash on her lower legs. On examination there is evidence of left basal crepitations and there is tender bruise like lesions on her shins. Bloods reveal a normal WCC, eosinophilia and elevated ESR. A CXR reveals a localised infiltration and hilar lymphadenopathy. Which of the following is the most likely diagnosis?

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