Sterile pustules that settle on an erythematous-edematous base

Abstract

A 73-year-old patient, with a history of type 2 diabetes mellitus, high blood pressure, hypothyroidism, heart failure, dyslipidemia and obesity, medicated with enalapril, metformin and levothyroxine, attended the Dermatology Service for generalized pruritic dermatosis, which had been going on for 48 hours. after starting treatment with amoxicillin/clavulanic acid, on external guard, due to a presumed infected ulcer in the distal third of the right leg.

On physical examination, she presented non-follicular pustules, with an erythematoedematous base and fine scales on the surface, located on the trunk, axillae and extremities.

The laboratory reported: white blood cells of 10,000mm3 with neutrophilic predominance, blood glucose of 226 mg/dl, CRP of 20 mg/L, ESR of 30 mm/h; The rest of the laboratory, abdominal ultrasound and chest x-ray were within normal parameters.

Pathological anatomy: spongiosis; accumulation of neutrophils on the corneal layer. Small blister with disintegrated and empty wall, moderate band-like lymphocytic inflammatory infiltrate located in the superficial, perivascular and periadnexal dermis. Dilated dermal capillaries.