Multiple drug hypersensitivity syndrome manifesting as acute generalised exanthematous pustulosis: A rare case report

Abstract

including depositional, infectious, medium to large vessel vasculitis, embolic, or thrombotic processes. With high clinical suspicion, ACD can typically be diagnosed with careful clinical history, and if needed, by patch testing, without requiring a skin biopsy or extensive laboratory workup. If biopsied, the presence of intraepidermal Langerhans cell microabscesses on histology has been suggested as a more specific feature of ACD. 6 However, when encountering retiform purpura, a biopsy for H&E and/or tissue culture, and potentially direct immunofluorescence, is critical. Although there was no histologic evidence of vascular compromise for this patient, his anticoagulation combined with repetitive trauma to the feet in the setting of spongiosis likely contributed to the purpuric presentation. This case demonstrates another differential diagnosis underlying retiform purpura and a unique manifestation of ACD.