PMC10067444_01
(A and B) Diffuse pruritic erythematous eruptions with nonfollicular pinhead-sized pustules (C) Perioral erosion and pus on the mucosal surface.
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Morphological features included oral and vulval mucosal inflammation, erosion with pus on the mucosal surface, diffuse pruritic erythematous eruptions with nonfollicular pinhead-sized pustules on the neck, trunk, and both upper extremities, along with purpura on the lower extremities (Figure 1).
Histopathology showing subcorneal pustules containing neutrophils on stratum corneum, papillary edema and perivascular infiltrate of lymphocytes on the superficial dermis ((A and B) for erythematous lesions); Skin biopsy showing basketweave stratum corneum with subcorneal pustules containing neutrophils, subepidermal and perivascular infiltrate of abundant lymphocytes and a small number of neutrophils and eosinophils on the superficial dermis ((C and D) for pustular lesions) (hematoxylineosin-saffron stain, original magnification x10, 2A and 2C: x20, 2B:x40, 2D).
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A skin biopsy revealed subcorneal pustules with epidermal spongiosis and perivascular inflammation of lymphocytes and eosinophils in the upper dermis and papillary edema (Figure 2). 
(A) On her hospital day 1: Just admission to hospital; (B) On her hospital day 14: After methylprednisolone (80 mg/4 days, 60 mg/4 days, 40 mg/4 days, ivgtt) treatment; (C) On her hospital day 16: Decreased dose to 32mg (po); (D) On her hospital day 24: After methylprednisolone (80 mg/10 days) and IVIG (10g/5 days); (E) On her hospital day 26: Decreased dose to 60 mg(ivgtt); (F) On her hospital day 34: After methylprednisolone (60 mg/5 days) and IVIG (10g/5 days). (G) On her hospital day 52: After methylprednisolone (60/40 mg 7 days) and discharged home from the hospital on a regimen of oral methylprednisolone (60 mg on odd days and 40 mg on even days).
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We proceeded cautiously with the withdrawal of the glucocorticoid according to our clinical observations (Figure 3).