UPP - Department of Dermatology, Dermatopathology Unit
Arthur Huen MD PhD, Gregory Ausmus MD, Arash Radfar MD PhD, Timothy Patton DO, John McSorley MD
NOVEMBER 2008 CASE OF THE MONTH
A 51 year old black woman was admitted to the hospital for a 1 year history of progressively worsening intermittent rash. She had been treated previously with mutiple courses of oral and topical antibiotics and antifungals. Most recently, her skin condition was treated with a course of cephalexin for presumed skin infection. She had prior skin biopsy performed, however, was lost to follow up for approximately 8 months before being admitted to the hospital.
Her past medical history includes rheumatoid arthritis (treated with etanercept that was discontinued approximately 1 year prior to presentation), left ventricular cardiomyopathy, hypertension and anemia of chronic disease.Skin of the upper chest, especially around the neck and axillae, demonstated numerous pustules on a background of hyperpigmented skin. Many erythematous erosions with collarette scale were also observed within these patches. Similar lesions were found in the inframammary fold.
Subcorneal pustulosis
Pustular psoriasis
IgA Pemphigus
Amicrobial pustulosis of the folds
SYD 09-378: Subcorneal pustules
SYD 08-8363: Subcorneal pustular dermotosis. Mild focal linear C3 at dermoepidermal junction
(Clin01.jpg) Figure 1. Left neck of the patient demonstrating pustules on a background of erythmatous patches with hyperpigmentation
(Clin02.jpg) Figure 2. Pustules, superficial erosions, and hyperpigmentation of left chest, axilla at left of image.
(Clin03.jpg) Figure 3. Pustules, superficial erosions, and hyperpigmentation of inframammary skin.
(H_E 01.jpg) Figure 4. Low power H&E. Subcorneal pustule with neutrophils and overlying scale crust. No acanthosis of the epidermis.Â
(H_E 02.jpg) Figure 5. High power H&E. Subcorneal pustule with neutrophils and pigment incontinence.
(H_E 03.jpg) Figure 6. PAS stain. Subcorneal pustule and absence of fungal organisms. (also negative for bacteria, Gram stain not shown).