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September 1994

A Papulovesicular Eruption Revealing Multinucleated Giant Cells on Tzanck Smear

Author Affiliations

he Johns Hopkins Medical Institutions, Baltimore, Md

Arch Dermatol. 1994;130(9):1195-1196. doi:10.1001/archderm.1994.01690090127021

REPORT OF A CASE  A 70-year-old white woman was admitted for evaluation of atypical chest pain. Initially she received diltiazem, nitropaste, and aspirin. Two days later, metoprolol, isosorbide dinitrate, and triazolam were added. On the fifth day of hospitalization, an intensely pruritic truncal rash developed, and a dermatology consultation was requested.Her history was significant for varicella infection as a teenager and a presumptive diagnosis of facial herpes simplex infection at age 67.On physical examination, she exhibited erythematous, slightly scaly, and focally vesicular and crusted papules, predominantly on the left upper back but also scattered on the right upper back and anterior shoulders (Figure 1). The Tzanck smear, stained using a modified Wright's stain (Diff-Quik Stain Set, Baxter Scientific Products, McGaw Park, Ill), showed multinucleated giant cells and acantholysis (Figure 2). A shave biopsy specimen was taken from a lesion on the right side of the back and stained

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