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JAMA Dermatology Clinicopathological Challenge
November 7, 2018

Disseminated Vegetating Plaques and Pustules

Author Affiliations
  • 1Case Western Reserve University, School of Medicine, Cleveland, Ohio
  • 2Harvard T.H. Chan School of Public Health, Boston, Massachusetts
  • 3Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
  • 4Department of Dermatology, University of California San Francisco School of Medicine, San Francisco
JAMA Dermatol. 2019;155(2):243-244. doi:10.1001/jamadermatol.2018.3708

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).

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