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).
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).
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