An 84-Year-Old With a Blistering Rash That Is Spreading

Tuyyab Hassan, MD


April 03, 2019

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


An 84-year-old woman presents with a blistering rash. The rash began 1 week ago on her right hand, but it has progressed to her arm, upper chest, and abdomen.

Figure 1.

Figure 2.

The rash is painless but intensely itchy, and it limits her ability to complete routine tasks. She has had no fever, no history of trauma, and no recent travel. She lives alone and uses an electric scooter to assist her with mobility. The patient relies on help from family and caretakers for activities of daily living.

She has a medical history of 100% estrogen-receptor-positive nonmetastatic breast cancer, ischemic heart disease, osteoporosis, and chronic renal insufficiency. The patient takes aspirin, isosorbide mononitrate, ramipril, simvastatin alendronate, and a calcium supplement. Her breast cancer is treated with an aromatase inhibitor. She has had no recent changes in her medication regimen and does not take any over-the-counter or herbal medications.


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