A 64-year-old African American woman presented to the emergency department for evaluation of bleeding mouth sores, tender crusted plaques on her scalp, and blisters on her skin. Three weeks previously, she noticed painful erosions throughout her mouth. A week later, painful blisters appeared on her upper extremities, trunk, and thighs. She also reported 2 pruritic and painful lesions on her scalp that had appeared 6 months prior, shortly after a chemical hair treatment. She had a history of alcohol, tobacco, cocaine, and marijuana use but denied current illicit drug use. She had not taken any medications prior to the appearance of the lesions. The patient reported a 2.25-kg weight loss, subjective fevers, and chills but no urinary symptoms.
Tran C, Wilder E, Griffin JR. Stomatitis, Cutaneous Bullae, and Renal Failure. JAMA. 2015;314(21):2296-2297. doi:10.1001/jama.2015.10735