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A 44-year old woman was admitted for a maculopapular rash with pruritus, facial edema, and fever 6 weeks after beginning treatment with diclofenac for lombalgias. On physical examination she had enlarged cervical and inguinofemoral lymph nodes, hepatomegaly, and a diffuse crackling noise on chest auscultation. She had a white blood cell count of 45 x 10³/µL with 38% eosinophils and mononucleosislike lymphocytes; normal platelet count; normal hemoglobin concentration with total IgE concentration of 1070 UI/L (normal concentration <100 UI/L); polyclonal gammopathy; elevated creatinine levels (1.56 mg/dL [138 µmol/L]); and no antinuclear antibodies or rheumatoid factors. Extensive serologic studies and cultures showed no bacterial, viral, or fungal infection. A chest radiograph showed a bilateral basal interstitial lung infiltrate. The patient’s status worsened rapidly as the diffuse maculopapular rash coalesced into an extensive erythematous (in places violaceous) eruption (Figure), and she experienced respiratory distress that required artificial ventilation. Histologic . . . [Full Text of this Article]

AUTHOR INFORMATION
Nicolas Schleinitz, MD; Véronique Veit, MD; Diane Coso, MD; Thérèse Aurran, MD; Phillippe Berbis, MD; Jean-Robert Harle, MD

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