Case
Report
A 43-year-old man was referred
from internal medicine to
the dermatology clinic with the
complaint of a fever and rash
of 3 day's duration.
The rash began on the face and
extended to involve other body areas.
His temperature was reported
to be between 38°
and 39° C and
did not cycle. He had a
history of a drug eruption 20
years ago, probably due to
antifebrile drugs. He noticed
the eruption soon after he was
treated with an antifebrile
suppository 3 days previously.
Past medical history was
non-contributory. The patient
was on no medications at the
time including previous
consumption of NSAID's in the
week preceding the incident.
On examination, there were many
finger-sized erythematous
macules over his entire body
and enlarged cervical lymph
nodes. Individual lesions felt
indurated to palpation but were
without tenderness. Blood cell
counts were
within the normal range, but
liver function test showed
abnormal elevation of GPT
(96U/ml) and gamma GTP (181
U/ml). Skin biopsy of an
involved area of the trunk
revealed slight edema in the
lower layer of the epidermis
and dermis, and marked cellular
infiltration including
lymphocytes, neutrophils, and
histiocytes in the dermis,
especially around small
vessels.
The patient was initially
considered to have a drug
eruption. However,
he was referred again to the
dermatology clinic 4 days later
because the fever and eruption
continued. On the careful
examination, an eschar was
found on the left axilla.
