Multiple choice: ACUTE GENERALIZED EXANTHEMATIC PUSTULOSIS

Abstract

A 46-year-old male, originally from San Miguel de Tucumán, with a personal history of ischemic stroke (CVA) with cerebral palsy, severe developmental delay and epilepsy, medicated with valproic acid, was admitted to the intensive care unit for SARS-CoV-2 pneumonia where he required invasive mechanical ventilation (IMV). Empirical treatment with amikacin and meropenem was started. After 48 hours, he presented a generalized rash and fever, so a consultation with the Dermatology Service was made. On physical examination, generalized erythematous-violaceous plaques were observed, on which non-follicular pustules were located, some with peripheral peeling; in addition, he had a low-grade fever. A skin biopsy was performed from a pustule located in the abdomen. Laboratory tests revealed anemia, leukocytosis with neutrophilia, mild thrombocytopenia, elevated transaminases, acute phase reactants, CPK and LDH. Serology for HIV, hepatitis B and C was requested, which were non-reactive, as was VDRL. Intravenous treatment with diphenhydramine 10 mg every 8 hours, meprednisone 1 mg/kg/day was started, and antibiotics were discontinued, which visibly improved the lesions. However, after 7 days the patient suffered complications associated with orotracheal intubation, which caused his death.