PMC8421674_01
(A-C) Rash on the back, legs, and abdomen at presentation, (D-F) Rash on the back, legs, and abdomen after steroid treatment.
fonc-11-726785-g001.jpg
PMC8421674_01_fonc-11-726785-g001.jpg
f1
Rash started on her trunk (Figures 1A, C) and rapidly progressed to involve her upper and lower extremities (Figure 1B). On physical examination, deep red macules and papules coalescing into patches and thin plaques were seen in the extremities and trunk (Figures 1A-C). Follow-up at 1 week showed significant improvement in the rash (Figure 1D), normalization of eosinophilia, and improvement in thrombocytopenia and elevated liver enzymes. Figures 1E, F show complete resolution of rash after 2 weeks of prednisone therapy.
H and E stain of right lower abdomen punch biopsy showing focal epidermal dyskeratosis, mild spongiosis, and moderate vacuolar interface dermatitis in association with superficial perivascular lymphohistocytic inflammation.
fonc-11-726785-g002.jpg
PMC8421674_01_fonc-11-726785-g002.jpg
f2
Left lower abdomen skin punch biopsy showed spongiotic dermatitis with focal interface dermatitis and high epidermal cytoids characteristic of morbilliform drug eruption seen in the setting of DRESS syndrome (Figure 2).