The Journal of the Arkansas Medical Society Issue 2 Vol 115 | Page 18

Special Section: Short Dermatological Cases
Derm Dilemma
Blake St. Clair, M3; Kevin St. Clair, MD
A
45-year-old man presents with
a six-week history of mild mal-
aise, arthralgias and myalgias,
and a generalized skin eruption. The
rash is characterized by 5-10mm red-brown
macules involving the trunk symmetrically, but
also noted on the palms and soles. He has also
experienced patchy hair loss on the scalp. The
only current medication is lisinopril, prescribed
for hypertension 10 months ago. His mother
suffers from lupus erythematosus.
Physical examination also reveals general-
ized adenopathy and moist white papules and
plaques on the penile shaft and scrotum.
Initial steps in evaluation should include
which of the following?
A. Immediate discontinuation of lisinopril
and evaluation of hepatic transaminases
and peripheral eosinophil count as this
patient most likely is developing DRESS
syndrome (drug rash with eosinophilia
and systemic symptoms)
B. Autoimmune serologies, especially ANA
(antinuclear antibody) as this man likely
has acute lupus erythematous
C. Viral culture of the mucosal lesions of the
groin, Herpes Zoster IgM titer, assess-
ment for underlying immunosuppression,
and empiric intravenous acyclovir as the
patient most likely suffers from Varicella
D. Nontreponemal serological screen-
ing with the Venereal Disease Research
Laboratory (VDRL) or rapid plasma regain
(RPR) assays as the patient most likely
has syphilis
42 • THE JOURNAL OF THE ARKANSAS MEDICAL SOCIETY
VOLUME 115