History: The patient is an otherwise healthy 67 year-old writer with a three month history of an intensely pruritic papular
and pustular dermatitis in an otherwise. He’s been on Welbutrin, HCTZ and Lipitor for
years. Previously treatments
with triamcinolone 0.1% ointment and prednisone for two weeks were not helpful.
O/E: There are
hundreds of 2 – 3 mm erythematous papules on arms, legs, torso, scalp. Face spared.
No lesions on hands, feet or genitalia.
Clinical Images:
Pathology:
Lab: CBC, Chemistries normal. Wound culure grew 2+ SAUR sensitive to everything.
The patient was treated with Keflex 250 mg qid for a week and Prednisone starting at 40 mg a day. He cleared quickly, but when he stopped the prednisone after ~ 3 weeks, the eruption and pruritus recurred. The new lesions are distinct erythematous papules mostly on the torso. Background looks normal.
The patient was treated with Keflex 250 mg qid for a week and Prednisone starting at 40 mg a day. He cleared quickly, but when he stopped the prednisone after ~ 3 weeks, the eruption and pruritus recurred. The new lesions are distinct erythematous papules mostly on the torso. Background looks normal.
Looks follicular ? gram negative.
ReplyDeleteBiopsy should help.
Does not look like a drug eruption to me.
Doug J