History:

This elderly lady presented with the sudden onsetof marked erythema and tenderness under her breasts and in the groin about 48 hours after being given Rulide for a chest infection.She had these small pustules at the edge of the erythema someof which eroded leaving open weeping areas.Presenting diagnosis was a pustular drug reaction with Staph scalded skin and Toxic epidermal necrolysis as differentials.Biopsies and swabs taken.

Path Report Sections show a biopsy of skin in which there is a subcorneal blister filled with neutrophils. The dermis contains a moderately dense superficial, mid and deep dermal infiltrate of eosinophils, neutrophils and some lymphocytes. There is exocytosis of neutrophils through the epidermis into the subcorneal blister. No fungal organisms can be seen. The features present are those of an acute pustular drug eruption.