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Off-Center Fold
January 2003

Sudden Onset of Multiple Painful Erythematous Papules and Pustules—Quiz Case

Author Affiliations


Arch Dermatol. 2003;139(1):93-98. doi:10.1001/archderm.139.1.93-a

A 74-year-old white man presented with multiple erythematous lesions and pustules on the right hand, the extensor area of the right forearm, and the occiput. In July 1996, he underwent a right hemicolectomy for Dukes stage B2 adenocarcinoma. Six weeks later, diplopia and dysarthria developed. At admission, imaging studies indicated soft tissue masses at both lung bases and the right sternoclavicular joint. Magnetic resonance imaging of the head revealed a 5-mm expansile solitary lesion in the right midbrain area. Oral dexamethasone therapy (16 mg/d) was initiated. Two weeks later, discrete, painful, erythematous ulcerations and pustules developed on the distal aspect of the third finger and left thumb of the right hand (Figure 1 and Figure 2). Similar lesions were noted on the extensor area of the right forearm, occiput, right flank, and right leg. A skin biopsy specimen was obtained (Figure 3).