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The patient, a 67-year-old man, went to the emergency department for a day with a diffuse rash.
had a history of prostate cancer treated with radiation therapy and was complicated by the development of stenosis in the urethra, for which he underwent surgery.
he was recently diagnosed with multiple osteoarthritis and myocarditis and began treatment with cephalosporineand vancomycin.
10 days after antibiotic treatment began, he noticed a burning sensation in his tongue, followed by rapid red spots and blisters in his abdomen, arms and legs.
physical examination revealed cysts in the armpits (shown in Figure A) and tongue (shown in Figure B), erythema with blisters in the abdomen, arms and legs, no fever, increased eosinophils or organ dysfunction.
biopsy specimens found neutrinophilitis accompanied by microblisters (figure C, HE staining).
direct immunofluorescence, IgA is linearly deposited along the substrate membrane region (figure D).
the patient was suspected of linear IgA herpes skin disease induced by vancomycin and terminated the treatment of vancomycin while continuing to use cephalosporine .
1 day after the patient stopped treatment with vancomycin, the lesions did not develop further.
1 month of follow-up, the patient's mucous membrane skin lesions completely disappeared.
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