PMC4531626_01
Erythematous papules (A) and pustule (B) on the palm aspect of the hand.
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On the 2nd day of treatment with the drug, she complained of severe myalgia, arthralgia and general weakness, and presented tender erythematous 2 cm-sized papules on the palms of her hands (Figure 1A). On the 3rd day of treatment the skin papules, which started on the palm, spread to the face, chest and neck, and progressed to maculopapular plaques or pustules (Figure 1B).
Microscopic findings: The skin biopsy showing dermal edema and intra- and sub-corneal pustular formation with diffuse epidermal infiltration of neutrophils, but no evidence of vasculitis. (A: H&E; x40), (B: H&E; x200).
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A punch biopsy of a skin lesion on her palm was performed, which showed intra- and sub-corneal pustular formation, with epidermal leukocytosis (Figure 2).