A teenaged male presented with a 2-week history of vegetating, bleeding plaques and pustules on his face, scalp, trunk, and extremities. He reported that lesions began as pustules and developed into painful, itchy plaques. Before evaluation at a referral hospital in Kenya, the patient was treated with prednisolone tablet 5 mg twice daily, clindamycin hydrochloride 300 mg daily, and fluconazole 200 mg daily, but he continued to develop new lesions. A complete review of systems was notable for the patient’s difficulty with walking because of skin lesions. On examination, pustules and hemorrhagic-crusted plaques were seen on the scalp, legs, arms, and trunk along with keloidal plaques on the face (Figure, A and B). Enzyme-linked immunosorbent assay testing for HIV was negative. A punch biopsy specimen from the arm was obtained for histopathologic study (Figure, C and D).
Seth D, Kiprono SK, Chang AY. Disseminated Vegetating Plaques and Pustules. JAMA Dermatol. 2019;155(2):243–244. doi:10.1001/jamadermatol.2018.3708
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