A 59-year-old African-American male with a past medical history of hypertension, hepatitis C presented to the emergency department in an unresponsive state. He was a known alcohol abuser and had a 30-pack-year smoking history. His medications included hydrochlorothiazide, amlodipine, and clonidine. He was found to have periorbital edema, numerous erythematous maculopapular and vesicular lesions on the eyelids, forehead, both upper extremities, and over the chest and upper abdomen, diffuse wheezing throughout lung fields and lip swelling. A diagnosis of acute renal failure secondary to rhabdomyolysis was made. A punch biopsy of the skin lesion revealed localized area of epidermal necrosis with subepidermal blister, underlying dermal necrosis, and patchy acute inflammatory changes.
This case is based on this article by Koya, Crenshaw and Agarwal in JGIM 2007.
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