Case Challenge - Groin Rash
A 45-year-old woman presents to the emergency department with a 2-day history of an acute-onset, mildly pruritic rash. The rash started in her axillae and groin and has since progressed to the rest of her body. She then developed a fever. She was diagnosed with pneumonia 4 days ago and has been taking azithromycin since that time. She was previously in good health, and her past medical history and family history are negative for psoriasis, arthritis, and other significant medical conditions. Blood cultures are positive for Mycoplasma pneumoniae but negative for additional bacteria or fungi. Culture and Gram stain of several pustules are obtained and are negative. A punch biopsy of a pustule on her leg is performed. The histology shows spongiform subcorneal pustules, edema of the papillary dermis, marked perivascular infiltration of neutrophils, and exocytosis of a few eosinophils. On the basis of only these findings, which is the most likely diagnosis? A. Acute generalized exanthematous pustulosis B. Leukocytoclastic vasculitis C. Pustular psoriasis D. Subcorneal pustular dermatosis E. Toxic epidermal necrolysis
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