PMC9978921_01
Initial presentation of pustular rash on hands and lower extremities approximately 1 year after initiating adalimumab.
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PMC9978921_01_crg-2022-0017-0001-529045_f1.jpg
F1
About 8 months later, the patient endorsed a new rapidly progressive pustular and painful rash on his bilateral upper and lower extremities (shown in Fig. 1).
Pathology of skin biopsy sections shows perivascular extravasation of erythrocytes, neutrophils, eosinophils as well as leukocytoclasis (vascular damage) surrounding blood vessels associated with fibrin. These findings are consistent with LCV. H&E stain, x10 magnification.
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PMC9978921_01_crg-2022-0017-0001-529045_f2.jpg
F2
Skin biopsy of the affected area was obtained, which demonstrated perivascular extravasation of erythrocytes, neutrophils, eosinophils, and leukocytosis surrounding blood vessels associated with fibrin (shown in Fig. 2).
Improvement in LCV 3 months after cessation of adalimumab and treatment with doxycycline and topical clobetasol.
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PMC9978921_01_crg-2022-0017-0001-529045_f3.jpg
F3
The patient was treated with topical clobetasol 0.05% and doxycycline 100 mg daily for 3 months with drastic improvement of the rash (shown in Fig. 3).