An acute acral papulovesicular eruption

A 58-year-old female patient was referred to our department for an acute acral vesiculobullous eruption present for 3 days. Her past medical history was unremarkable. The sudden onset of the painful vesiculobullous lesions (within 3 days) was extremely troublesome to the patient. Cutaneous examination revealed multiple erythematous and edematous round plaques with overlying ulcerated bullae and vesicular lesions on the forearms (Fig. 1a). Her oral mucosa was involved since she had superficial erosions on the lips with aphthous lesions (Fig. 1b). Concomitant with the cutaneous eruption, she also had a red painful right eye with no blurred vision. Ophthalmologic examination revealed two scleral nodules with surrounding episcleral injection located on the temporal and medial aspects of the right eye (Fig. 1c). The cornea was clear, and there was no anterior chamber activity consistent with the diagnosis of nodular scleritis. The patient also complained of fever and arthralgia of the knees and ankles. Laboratory investigation was notable with elevated leukocyte count with neutrophilia (neutrophils 87%). The erythrocyte sedimentation rate and C-reactive protein concentration were elevated at 80 mm and 54 mg/l, respectively. Renal and liver function were normal. HIV serology was also performed and was nonreactive.