[SavageGlow]

A healthy man in his 40s presented with 5 days of vesiculobullous eruption with interspersed targetoid plaques (figures 1 and 2), starting over his chest before extending to the rest of his body. It was preceded by fever, sore throat and diarrhoea. The patient’s general practitioner prescribed acyclovir to no effect. No other medication had been commenced and he denied anabolic steroid use. The patient is a teacher and plays waterpolo. He denied other outdoor activities, animal exposure, insect bites or recent travel. Investigations revealed a raised C reactive protein of 285 mg/L, erythrocyte sedimentation rate of 40 mm/hour and white cell count of 21.8×109/L, predominantly neutrophilic. He required admission and was started on piperacillin-tazobactam and clindamycin for possible streptococcal/staphylococcal infection. The dermatologists took lesional biopsies for H&E and perilesional biopsies for direct immunofluorescence. A tailing down prednisolone course was also commenced.

Blood cultures, antinuclear antibody, mycoplasma IgM and antistreptolysin O titre were negative as was the viral screen for Varicella, COVID-19, Epstein-Barr virus, cytomegalovirus, hepatitis, HIV and herpes simplex. In view of this and the rapid response to steroids, antibiotics were stopped, and he was discharged after 6 days.

[Suicide_Note]

Yikes!