Acta Dermato-Venereologica issue 50:1 98-1CompleteContent | Page 49

163 Disseminated Vesicular Rash in an Immunocompetent Adult Woman: A Quiz Trine HØGSBERG and Anette BYGUM Department of Dermatology, Odense University Hospital, Søndre Blvd 29, DK-5000 Odense C, Denmark. E-mail: [email protected] A 51-year-old woman was hospitalized due to an itchy, generalized rash, which had been present for 5 days. She had concomitant sore throat, oral lesions and some genital irritation. Before admission, she had visited her family prac- titioner and emergency service, where she was prescribed nobligan. A practicing dermatologist suspected vasculitis and took a skin biopsy. No known exposures could be identified. She was wor- king as a teacher for adults, and did not know of any people with infections in her social circle. For 2 years she had been treated with a stable dose of escitalopram. Clinical examination revealed multiple red papulovesi- cular and pustular lesions distributed mainly on the trunk, but also to a lesser extent on the limbs including the palms and soles (Fig. 1). She had vesicles and small erosions around her lips and inside her mouth, general malaise, retrosternal pain on swallowing, and had been vomiting. She had no fever and had reported no other complaints. Blood testing showed mild lymphopenia and marginally raised C-reactive protein 27 (< 6). Skin biopsy revealed extensive necrosis of the epidermis with a few scattered lymphocytes. Dermal oedema was seen with a lymphocytic infiltrate, but no signs of vasculitis. Histopathology suggested erythema multiforme or toxic epidermal necrolysis. What is your diagnosis? See next page for answer. QUIZ SECTION Fig. 1. Multiple papulovesicular lesions confluent on the trunk and centred around the mouth and macular punctate lesions on the palms and soles. Written permission was provided by the patient to publish these photographs. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2771 Acta Derm Venereol 2018; 98: 163–164