| Popis: |
A 60-year-old man presented with a rash that had developed during the previous 2 weeks. He had not experienced any symptoms of influenza or any other symptoms before the onset of the rash. The rash started on his scrotum and spread to his buttocks and then to his entire body. His face was spared, but he had pain inside his mouth. He first noticed a red, tender, pinpoint lesion on his scrotum, which became progressively larger with associated desquamation, pruritus, and worsening pain. An initial trial of topical hydrocortisone and then high-dose oral prednisone for 1 week was unsuccessful. He had no fevers or rigors. His medical history was unremarkable. Recent medications included corticosteroid preparations prescribed by his primary care physician. He had no known drug allergies. He drank alcohol occasionally but denied any recreational drug or tobacco use. He also denied any recent travel or unusual exposures. On examination, the patient was afebrile; his blood pressure was 130/73 mm Hg and his heart rate was 123 beats/min. He appeared in distress secondary to pain. Fissures were visible over the angles of the mouth. The oral mucosa was dry, erythematous, and edematous, but no blisters, erosions, or ulcers were observed. Conjunctival erythema was present bilaterally without mucopurulent discharge. Skin examination revealed confluent, macular erythema with reticulation and desquamation on most of the patient's body surface area (Figure). The hands were edematous with satellite red macules and papules with central desquamation. FIGURE. Confluent, macular erythema with reticulation and desquamation affecting the patient's body. |
