A 44-Year-Old Man Comes to the Emergency Department Due to a Diffuse

question 201

Multiple Choice

A 44-year-old man comes to the emergency department due to a diffuse, painful skin rash that began abruptly 2 days ago.  He has also had fever and malaise but no cough, shortness of breath, abdominal pain, diarrhea, dysuria, or joint pains.  Three years ago, the patient was diagnosed with plaque psoriasis involving the scalp, elbows, and knees.  He was treated with a high-potency topical corticosteroid ointment, which has improved his symptoms.  He stopped using the ointment a week ago.  He also has a history of untreated chronic hepatitis C.  The patient is sexually active and uses condoms inconsistently.
Temperature is 38.7 C (101.8 F) , blood pressure is 130/70 mm Hg, and pulse is 98/min.  There is no scleral icterus or lymphadenopathy.  Oropharyngeal mucous membranes are normal.  Skin examination reveals erythema and lesions as shown below involving his trunk, neck, and extremities.

Which of the following is the most likely diagnosis?

• A)Acute pustular psoriasis
• B)Disseminated gonococcal infection
• C)Generalized herpes simplex virus infection
• D)Staphylococcal skin infection
• E)Toxic epidermal necrolysis