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April 1997

Generalized Pustular Rash and Erythema

Author Affiliations

Friedrich-Schiller-University, Jena, Germany

Arch Dermatol. 1997;133(4):503-504. doi:10.1001/archderm.1997.03890400103015

REPORT OF A CASE  A 56-year-old man presented with a 4-day history of a rapidly evolving erythematous and pustular rash. He suffered from general malaise, pruritus, and fever (temperature, up to 40°C). On the day before he presented, a dental abscess had been incised and oral 6-α-phenoxybutyramide had been prescribed. Cultures taken from the abscess yielded Xanthomonas maltophilia and Acinetobacter baumannii. Examination of the patient's skin revealed a generalized erythematous rash with numerous, nonconfluent, follicular pustules measuring approximately 2 to 3 mm in diameter (Figure 1). Mucosal involvement was absent. The patient reported burning and itching sensations.A skin biopsy specimen was obtained for routine light microscopy and immunohistological analysis (Figure 2 and Figure 3). Laboratory tests revealed the following values: leukocytes, 3.8×109/L; erythrocyte sedimentation rate, 68/120 mm/h; C-reactive protein, 270.8 mg/L (normal, <5 mg/L), and serum creatinine, 242 μmol (2.7 mg/dL) (referencerange, 53-88 μmol/L [0.6-1.0mg.dL]).The