Rapid Onset of Pustular Plaques

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Abstract
REPORT OF A CASE A 75-year-old man presented to the emergency room with a six-day history of rapidly progressing skin lesions on his extensor forearms and shoulders. The lesions began as small papules that coalesced into tender hemorrhagic bullous and pustular plaques (Figs 1 and 2). The patient had a history of psoriasis but no similar skin lesions. On examination, in addition to the skin lesions, the patient was noted to have a temperature of 38°C and an enlarged spleen, which was palpable 3 cm below the left costal margin. Laboratory studies revealed a white blood cell count of 25000/mm3 (25 × 109/L), with a differential cell count of 81% (0.81) segmented neutrophils, 3% (0.03) band cell forms, 3% (0.03) lymphocytes, 6% (0.06) myelocytes, 2% (0.02) promyelocytes, 5% (0.05) blast cell forms; a hematocrit of 31% (0.31); and a platelet count of 104 × 103