PMC7477587_01
Patient's forearms four weeks following the original erupting rash. Pictured here are follicular erythematous papules with scattered postinflammatory hyperpigmented macules becoming confluent in areas with desquamation. This pattern persisted bilaterally in the trunk and upper and lower extremities.
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The rash began two weeks prior in the left arm and gradually spread bilaterally to the trunk, face, oropharynx, periocular space, and legs (Figure 1).
Low-power microscopy images of the patient's skin biopsy (40x and 100x) show interface dermatitis with focal spongiotic dermatitis. On the high-power image, (400x) there is vacuolar interface dermatitis (lymphocytes tagging along the dermoepidermal junction) and rare necrotic keratinocytes within the epidermis. The histopathologic changes are nonspecific but can be observed in drug eruption reactions.
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ALT : 42 IU/L). Initial evaluation by the dermatology service suggested a differential diagnosis of AGEP secondary to amoxicillin versus DIHS secondary to lamotrigine or carbamazepine use. A computed tomography (CT) scan revealed no clear etiology of infection, blood cultures were negative, skin cultures from pustules only grew normal skin flora, and skin biopsy revealed nonspecific findings most consistent with AGEP (Figure 2).