Prepared by Bhuvaneswari Gowthaman, MD, Resident, Internal Medicine, and Daniel G. Arkfeld, MD,
Assistant Professor, Keck School of Medicine, University of Southern California, Los Angeles, Calif
A 59-year-old Hispanic woman with rheumatoid arthritis presents to the emergency department with 3 weeks' duration of a progressively worsening skin rash that had been recurring over the past 3 years. The patient denies any involvement of the mouth, eyes, or other mucosal surfaces. Physical examination showed extensive areas of ruptured bullae and erythematous skin erosions involving her face, chest, back (Figure 1), and extremities (Figure 2) without mucosal lesions. Laboratory values were normal, except for an erythrocyte sedimentation rate of 53 and a mildly elevated white blood cell count of 12.0 x 109/L.
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