Papular Acneform Eruption With Mucositis

Abstract

A 48-year-old man with a history of ulcerative colitis that was well-controlled with adalimumab presented with a generalized acneiform eruption involving the face, chest (top) and back, as well as a well-defined ovoid ulcer on the anterior aspect of the tongue (bottom) of 2 months' duration. Prior treatment with prednisone 60 mg daily for 14 days resulted in no improvement. He denied unintentional weight loss, cyclic fever, or arthritis. A complete blood cell count with differential showed mild anemia (hemoglobin, 11.6 g/dL [reference range, 13.2-16.6 g/dL]) with a differential cell count that was within reference range for each cell type. The erythrocyte sedimentation rate was elevated at 44 mm/h (reference range, 0-22 mm/h). A 4-mm punch biopsy specimen of an indurated cystic papule on the torso was obtained.WHAT'S YOUR DIAGNOSIS? a. Behçet disease b. pustular psoriasis c. SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome d. steroid-induced acne e. syphilis From the Mayo Clinic,