ABSTRACT
We describe a 69-year-old white man with a recent history of a left forearm sarcoma resection treated with a split-thickness skin graft and radiotherapy who presented with cellulitis of the left forearm, for which a 2-week course of trimethoprim-sulfamethoxazole was prescribed. Ten days into treatment, he presented with flu-like symptoms and a rash. He was eventually diagnosed with Stevens-Johnson syndrome accentuated on the donor split-thickness skin graft on the left thigh region mimicking a recall reaction. There are no other reported cases of Stevens-Johnson syndrome localized within donor graft sites; therefore, this case may represent a novel form of recall reaction.
ABSTRACT
A 59-year-old woman with end-stage renal disease presented for suspected Stevens-Johnson syndrome that was ultimately diagnosed as generalized bullous fixed drug eruption (GBFDE) secondary to the administration of iodinated nonpolar radiocontrast. The patient had three previous episodes of a generalized bullous eruption after a thrombectomy, fistulogram, and an arteriovenous fistula revision, all requiring radiocontrast administration. Biopsies taken after previous eruptions demonstrated full-thickness epidermal necrosis, and she was diagnosed with Stevens-Johnson syndrome thought to be due to allopurinol. However, against medical advice she continued taking allopurinol and remained asymptomatic until the current presentation. Based on the clinical appearance and time frame of the eruptions, the patient was diagnosed with GBFDE due to radiocontrast. GBFDE, a rare variant of a fixed drug eruption, can be misdiagnosed as Stevens-Johnson syndrome due to their overlapping features of drug-induced whole-body blisters and variable degrees of epidermal necrosis.
ABSTRACT
We describe a 2-year-old girl who presented to the emergency department for a 2-day history of a rapidly spreading, pruritic, erythematous rash. There were large polycyclic annular erythematous wheals on the face, trunk, and extremities. Urticaria multiforme was diagnosed. Systemic antihistamine therapy greatly regressed the dermal lesions in 24 hours. Urticaria multiforme, a benign cutaneous hypersensitivity reaction, is commonly misdiagnosed as erythema multiforme or a serum sickness-like reaction. Our case highlights the importance of differentiating urticaria multiforme to prevent unnecessary tests and provide proper treatment.
ABSTRACT
We present the rare case of ischemic fasciitis in an elderly man with a history of Parkinson's disease. The patient presented with multiple subcutaneous masses on his lower back, ranging in size from 3 to 8 cm. Histopathologic evaluation showed areas of deep dermal and subcutaneous fibrinoid necrosis with granulation tissue-like vessels as well as reactive fibroblasts. The histopathologic presentation as well as the clinical presentation confirmed ischemic fasciitis as the etiology. Ischemic fasciitis, also called atypical decubital fibroplasia, is a rare entity characterized by a reactive, nonneoplastic proliferation of atypical fibroblasts. Though a benign pseudosarcoma, it is often confused with a sarcoma due to their similar clinical and histological presentation. Recognition of this distinct benign entity is essential to avoid misdiagnosis.
ABSTRACT
Darier disease (DD), also known as keratosis follicularis or Darier-White disease, is a rare autosomal dominant genodermatosis that presents as hyperkeratotic, warty papules affecting the seborrheic and intertriginous areas. Patients with DD are at risk of secondary infections including the rare complication of Kaposi varicelliform eruption (KVE), a widespread viral infection most commonly caused by herpes simplex virus (HSV). Darier disease with secondary KVE can lead to widespread systemic infection and death. This case report discusses an individual with DD who subsequently developed KVE due to disseminated HSV type 2 infection.
