CME Case Challenge: A 45-year-old man presented with 4 days of fevers up to 39°C and a diffuse pustular rash on the upper body. Clinical history was notable for recent nocturia and urinary hesitancy for which he was empirically prescribed sulfamethoxazole/trimethoprim. The patient discontinued this antibiotic after 3 days due to diarrhea and subsequently started levofloxacin. Within 24 hours, the patient developed a descending pustular rash starting on his head. Physical examination found edematous, erythematous, follicular pink and yellow-tinged coalescent papules and plaques on the cheeks, trunk, and upper extremities (Figs 1 and 2). A punch biopsy was taken from the chest (Fig 3). What’s the most likely diagnosis?
- A. Drug-induced acute febrile neutrophilic dermatosis (Sweet syndrome)
- B. Generalized pustular psoriasis, von Zumbusch type
- C. Neutrophilic eccrine hidradenitis
- D. Neutrophilic sebaceous adenitis
- E. Acute generalized exanthematous pustulosis
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