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Fulminant Cutaneous Eruption in a 51-Year-Old Man


Fulminant Cutaneous Eruption in a 51-Year-Old Man


حالة سريرية

الوصف الكامل Background
A 51-year-old African American man presented with a 2-month history of a painful, nonpruritic, worsening cutaneous eruption that had started on his lower extremities and had spread over his entire body.
القصة المرضية HPI
The patient, whose medical history was otherwise unremarkable, denied systemic symptoms and had not taken any medications before the onset of the eruption. His condition initially improved on a regimen of high-dose oral steroids (prednisone, 60 mg/d) but flared when the dosage was tapered.
الفحص السريري Clinical Exam
Physical examination revealed crusted erosions, flaccid bullae with pus, well-circumscribed shallow ulcers, and dusky, erythematous circinate plaques on the scalp, face, trunk, and extremities (Figure 1).
الاستقصاءات Investigations
A complete blood cell count revealed an elevated white blood cell count (24.1×103/μL [reference range, 4.5-11.0×103/μL]) with 89 segmented neutrophils (reference range, 31-76), 4 band cells, and 1 lymphocytes (reference range, 24-44). Bone marrow biopsy and flow cytometry revealed no abnormalities. All body fluid and skin cultures showed no growth of organisms. A serum chemistry profile showed hypocalcemia and hypoalbuminemia. Serologic tests were negative for human immunodeficiency syndrome, hepatitis, and syphilis and positive for Epstein-Barr virus. Biopsy specimens were obtained from the chest and right thigh (Figure 2 and Figure 3).
Dr.Hazem's picture
by
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from the pic. i think it is Purpura Henoch Schoenlein

????????

Dr.Syrian's picture
Dr.Syrian
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bullous pepmphigoid
it could be pepmphigus vulgaris but in the absence of a history of mucous memberane involvement things look a bit gloomy
I need more history and IF staining of a skin specimen

Dr_Ayyad
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no it's not purpura henoch schoenlein
it is bullous pemphigoid but the picture does not show subepidermal edema or cyst.??? what about the IgG antibody???
Hot sauce's picture
Hot sauce
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aha ok.
the Treatment what should we give him?
Corticosteroids or immunosuppressive medications such as methotrexate, or cyclophosphamide?

or chemotherapy?

Dr.Syrian's picture
Dr.Syrian
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I am really not good in dermatology:Sad sad: but I think corticosteroids???Rolling Eyes Rolling Eyes Rolling Eyes may be Dr Ayad will give us the right answer as Step2 student
Hot sauce's picture
Hot sauce
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رغم أنني لست جيدا في الجلدية ولكنني أقول:

ليس فرفرية هينوخ شونلاين لأنها تكون حادة الظهور و الزوال وعند الأطفال غالبا وهي فرفرية وليست فقاعات وانحلال بشرة

وليست فقاعا شائعا لأنه غالبا يظهر في المخاطيات أولا ثم الجذع والسرة والثنايا وأخيرا قد ينتشر إلى الأطراف السفلية

الفقاعاني الفقاعي وارد أكثر لأنه يبدأ في الأطراف ولأن عمر المريض 51 سنة يناسب المرض أكثر

أما التهاب الجلد حلئي الشكل فيكون أشبه بالحلأ أي أن الحويصلات صغيرة ومتوزعة في مجموعات متناظرة
كما أنه ناكس ويصيب الأصغر سنا 30 سنة غالبا

dr.sa3eed
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I would suggest guys that you should write these discussions in arabic because although I
can understand what u are saying but 80% of our students can't
dr.sa3eed
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