Finding Solutions to Challenging Cases: Next Steps

The presentation discusses two challenging cases of uncommon blistering conditions, with a focus on their clinical features, diagnosis, and treatment. The first case involves a 60-year-old male who developed blistering after starting several medications for pneumonia. The diagnosis of linear IgA disease was confirmed through skin biopsy, revealing sub-epidermal blistering and a linear pattern of IgA. The case highlighted the importance of identifying drug triggers for linear IgA, transitioning from a focus on vancomycin to considering other medications. Subsequently, the patient was treated with dapsone and prednisone but was readmitted with lower leg weakness, which turned out to be due to prednisone-induced myopathy, revealing a concurrent diagnosis of Guillain-Barré syndrome likely triggered by an influenza vaccine.



The second case centers on a 68-year-old female with a history of type 1 diabetes and renal disease, who presented with facial swelling and ulcerations. Initially treated for suspected cellulitis, her condition led to a suspected diagnosis of lupus. However, upon further evaluation and skin biopsy, a diagnosis of a cryptococcal variant of Sweet syndrome was made. This case underscored the potential overlap in symptoms between lupus and Sweet syndrome, especially in patients taking hydralazine, which can occasionally lead to a trifecta of drug-induced lupus, vasculitis, and Sweet syndrome. The discussions concluded with pearls of wisdom for clinical assessment and treatment considerations of these complex cases.