ABSTRACT
A 64-year-old Caucasian woman is evaluated by the inpatient dermatology consult service after being admitted to the hospital for an acute onset of high fever and a rash on the dorsal hands, neck and face. Two weeks prior to her presentation, the patient noticed easy bruising, nosebleeds and fatigue. A review of systems is positive for fever, arthralgia and sensitivity to light. On examination, the surrounding skin on the dorsum of the hands is erythematous and tender to touch. There are multiple edematous hemorrhagic bullae, which have developed over the last 24 hours of her hospital admission (32). A CBC reveals a white cell count of 37,000 cells per microlitre with 10% blasts. A skin biopsy is performed and histopathologic examination demonstrates superficial papillary edema along with numerous polymorphonuclear leukocytes, some of which exhibit karyorrhexis, within the papillary and mid-dermis.
