18 yo Caucasian female presented to the ER with a day history of a painful, dusky erythematous rash on her anterior trunk, back, buttocks, and posterior legs (Figs 1-3). The patient had been receiving methotrexate 25 mg IM weekly for the past three weeks for a hydatidiform mole. She denied any recent history of sunburns or radiaton exposure, though she did report regular tanning bed use, which was stopped less than one week prior to initiating methotrexate therapy.
Skin examination revealed diffuse areas of dusky erythema covering ~30% of the body surface area on the chest, back, buttocks, and posterior legs. Several bullae and multiple fine vesicles were noted on the buttocks and popliteal fossa. There was no mucosal or ocular involvement.
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