History: 52 y/o Male presented with an acute (1 day) onset of a diffuse rash. Started off as redness on his chest and neck and then spread within 24 hours with the development of pustules most prominently on the face, chest, back, abdomen and neck. The rash was associated with swelling and itching. Patient endorsed fevers but denied any other ROS.
PMH: chronic systolic heart failure, gout, h/o of gangrene s/p graft, hypertension
Social Hx: Student, denies alcohol, tobacco, or illicit drug use
Family Hx: Non contributory
Medications: allopurinol, lisinopril, spironolactone, metoprolol, furosemide, aspirin
Allergies: No Known Drug Allergies
Physical Exam: (Figure 1 and 2)
General: No Acute Distress, Alert and oriented x 3, Febrile
Skin: multiple grouped pustules on the face, neck, upper chest, upper back, and few scattered on the arms and abdomen with diffuse underlying erythema; pustules most prominently located on the face, with also the presence of significant honey colored crusting; + facial and neck edema
Initial results: CBC = Elevated WBC 12.6; Cr: 1.11; AST/ALT: 68/79; blood culture = negative;
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