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Case Records of the Massachusetts General Hospital
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Volume 360:2771-2777 June 25, 2009 Number 26
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Case 20-2009 — A 79-Year-Old Woman with a Blistering Cutaneous Eruption
Mathew M. Avram, M.D., J.D., and Mai Hoang, M.D.

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Presentation of Case

Dr. Jordan M. Cummins (Dermatology): A 79-year-old woman was admitted to the burn unit of this hospital because of a blistering cutaneous eruption.

Five days before admission, itching on her head and back and skin lesions on her abdomen developed. She saw her primary care provider at another facility. She had had polymyalgia rheumatica, giant-cell arteritis, and rheumatoid arthritis for many years, treated with prednisone. Hydroxychloroquine had been started approximately 2 weeks earlier. The hydroxychloroquine was stopped and loratadine was administered; prednisone was continued. The rash did not improve and gradually spread to her back, arms, and legs. Three days . . . [Full Text of this Article]

Differential Diagnosis

Acute Exfoliative Dermatoses

            The Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

            Erythema Multiforme

            Drug Hypersensitivity with Eosinophilia and Systemic Symptoms (DRESS) Syndrome

Infectious Desquamating Eruptions

Pustular Eruptions

            Infectious

            Noninfectious

Acute Generalized Exanthematous Pustulosis

Dr. Mathew Avram's Diagnosis

Pathological Discussion

Anatomical Diagnosis


Source Information

From the Departments of Dermatology (M.M.A.) and Pathology (M.H.), Massachusetts General Hospital; and the Departments of Dermatology (M.M.A.) and Pathology (M.H.), Harvard Medical School.



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