Generalized pustular eruption associated with converting enzyme inhibitor therapy.
A 67-year-old man presented with a high fever and a generalized rash. His extended hospital stay was characterized by fever with repeated staphylococcal bacteremia and the appearance of axillary lymphadenopathy and splenomegaly. Skin lesions became hyperpigmented, dry, and atrophic with areas of exfoliation and uclers. Examination of skin and lymph node biopsy specimens showed findings consistent with mycosis fungoides. The patient unexpectedly recovered on discontinuation of captopril. A positive macrophage inhibiting factor response for both captopril and enalapril indicated that the non-sulfhydryl moiety was the antigenic stimulant for the lesion resembling mycosis fungoides.
Carroll
J
J
A.J. Chorley Institute for Hypertension, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Thaler
M
M
Grossman
E
E
Alder
A
A
Trau
H
H
Rosenthal
T
T
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D000959:Antihypertensive Agents / Q000009:adverse effects*; D016470:Bacteremia / Q000382:microbiology; D002216:Captopril / Q000009:adverse effects*; D003875:Drug Eruptions / Q000209:etiology*; D006801:Humans; D017495:Hyperpigmentation / Q000139:chemically induced; D008297:Male; D009182:Mycosis Fungoides / Q000139:chemically induced*; D012883:Skin Ulcer / Q000139:chemically induced; D013203:Staphylococcal Infections; D014581:Urticaria / Q000139:chemically induced
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002216:Captopril