Neutrophilic Dermatosis

This article is an answer to the case – Fever and Painful Blisters on Arms, Legs, and Face

Despite treatment with antibiotic agents and acyclovir, the lesions progressed. Tests for infectious causes, including blood cultures, serologic testing for Epstein–Barr virus and Mycoplasma pneumoniae, wound testing for herpes simplex virus and varicella zoster virus, and bacterial culture, were negative.

On hospital day 5, a new skin ulcer developed on the right hand at an intravenous cannula site. Pathergy, the development of new lesions induced by minor trauma, may be seen in patients with neutrophilic dermatoses such as postinfectious Sweet’s syndrome and bullous pyoderma gangrenosum.

A biopsy sample of the ulcer showed a dense neutrophilic infiltrate extending to the base of the lesion, a finding consistent with a neutrophilic dermatosis.

The lesions abated with methylprednisolone and oral cyclosporine therapy and wound care. At follow-up 12 months later, most of the lesions had almost completely resolved, with no evidence of ongoing inflammation.