SHM Converge Scientific Abstract ePoster Gallery-A High Stakes Rash: Subcorneal Pustular Dermatosis Mimicking Dress Syndrome in a Patient With Metastatic Breast Cancer

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This case describes a 76-year-old woman with metastatic breast cancer and recent vancomycin treatment for MRSA bacteremia who developed a diffuse erythematous pustular rash. Because she also had leukocytosis, neutrophilia, and eosinophilia, the initial concern was vancomycin-associated DRESS syndrome. However, she had no mucosal involvement, blistering, or clear systemic organ injury, and her neurologic symptoms resolved with negative stroke workup.<br /><br />Dermatologic examination showed widespread coalescing papules and plaques involving the back, buttocks, abdomen, cheeks, and proximal thighs. A skin shave biopsy demonstrated subcorneal collections of neutrophils, confirming subcorneal pustular dermatosis (SPD), also known as Sneddon-Wilkinson disease. This pathology was key in distinguishing SPD from a severe drug reaction such as DRESS.<br /><br />She was treated initially with high-dose corticosteroids and then transitioned to dapsone, with marked clinical improvement. Outpatient follow-up was planned to consider TNF-alpha inhibitor therapy if needed.<br /><br />The case highlights the diagnostic challenge of differentiating SPD from DRESS in immunocompromised patients, especially when eosinophilia and recent antibiotic exposure are present. It emphasizes that histopathology and clinical correlation are essential to avoid misdiagnosis, unnecessary immunosuppression, and delayed appropriate therapy. While SPD is associated more often with hematologic disorders than solid tumors, its relationship to this patient’s metastatic breast cancer remains uncertain and may be coincidental or related to broader immune dysregulation.

Asset Subtitle

Kayal Parthiban

Meta Tag

Author List Colleen Gabel, Kayal Parthiban, Patrick O'Donnell, Srividhya Lakshmanan

Category Clinical Vignettes

Concept Subcorneal Pustular Dermatosis

Concept Subcorneal Neutrophilic Pustule

Concept Drug-Induced Hypersensitivity Syndrome

Concept Skin Biopsy

Concept Dapsone

Distinguished Non-Finalist

Presenter Organization UMass Chan Medical School

Presenting Author Kayal Parthiban

Track Adult

Keywords

subcorneal pustular dermatosis

Sneddon-Wilkinson disease

DRESS syndrome

vancomycin reaction

MRSA bacteremia

eosinophilia

dapsone treatment

skin biopsy

metastatic breast cancer

pustular rash

Subcorneal Pustular Dermatosis

Subcorneal Neutrophilic Pustule

Drug-Induced Hypersensitivity Syndrome

Skin Biopsy

Dapsone