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Diagnostic Dilemma: Dermatology

Diagnostic Dilemma: Dermatology

Test your diagnostic skills with the following endoscopic quiz.

A 51-year-old man presented to the Dermatology Section at the University of Chicago Medical Center in August 2007 with a pruritic, papulopustular eruption on the face. He had been started 4 weeks ago on induction chemotherapy with paclitaxel, carboplatin, and cetuximab (Erbitux) for hypopharyngeal squamous cell carcinoma (T2N3M0). He denied any prior history of acne or rosacea.

Physical examination revealed a well-appearing man in no acute distress. There were multiple erythematous papules and pustules on his face, with overlying hemorrhagic and honeycomb-like crusts (see Figures A and B). He was afebrile and the vital signs were normal. There was no lymphadenopathy, and the liver and spleen were not palpable. The remainder of the physical examination was unremarkable.

Laboratory evaluation showed white blood cell count 4.5 K/µL and hematocrit 39.6%. Comprehensive chemistry panel was normal except for potassium 3.3 mEq/L and SGPT 36 U/L. Bacterial and viral swabs were taken for culture.

1) The photographs reveal findings noted at the time of a diagnostic and therapeutic procedure. What is your diagnosis?

(a) Impetigo contagiosa
(b) Acneiform (papulopustular) drug eruption
(c) Pyoderma faciale (rosacea fulminans)
(d) Herpes simplex virus infection

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