Case presentation
A 45-year-old man presented with 4 days of fevers up to 39°C and a diffuse pustular rash on the upper body. Clinical history was notable for recent nocturia and urinary hesitancy for which he was empirically prescribed sulfamethoxazole/trimethoprim. The patient discontinued this antibiotic after 3 days due to diarrhea and subsequently started levofloxacin. Within 24 hours, the patient developed a descending pustular rash starting on his head. Physical examination found edematous, erythematous, follicular pink and yellow-tinged coalescent papules and plaques on the cheeks, trunk, and upper extremities (Figs 1 and 2). A punch biopsy was taken from the chest (Fig 3).
Fig 1.
Fig 2.
Fig 3.
Question 1: What is the most likely diagnosis?
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A.
Drug-induced acute febrile neutrophilic dermatosis (Sweet syndrome)
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B.
Generalized pustular psoriasis, von Zumbusch type
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C.
Neutrophilic eccrine hidradenitis
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D.
Neutrophilic sebaceous adenitis
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E.
Acute generalized exanthematous pustulosis
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Footnotes
Funding sources: None.
Conflicts of interest: None disclosed.