History: A 47 year-old man presented to the Emergency Department with several weeks of blisters on the hands. He had previously been admitted to the hospital twice by orthopedic surgery for debridement of the lesions and treatment with IV antibiotics for presumed abscesses. A dermatology consult was called as the patient’s condition had not improved.
Past medical history: Cystic acne, hidradenitis suppurativa
Physical exam: Edematous papules, hemorrhagic bullae and ulcers on the dorsal hands (Fig. 1)
Labs: ESR 85, CRP 199, HIV negative, Hepatitis panel negative, Tissue culture negative
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