Pathology: Chronic autoimmune mucocutaneous disease against desmosomes in epidermis
- painful; rarely pruritic; afebrile
- flaccid bullae but may start tense, +Nikolsky's sign
- mucosal involvement common
- Bullous pemphigus: Have tense bullae (may start with urticarial lesions), negative Nikolsky's sign, mucosal involvement less likely
Diagnosis: clinical; biopsy is gold standard.
A 32 year old male history of IV drug use presents for redness to his right arm extending the antecubital fossa. He has pain out of proportion to the area and pain outside of the erythematous margins. He is febrile to 103.2 F, heart rate is 125, blood pressure is 80/40. Patient is given normal saline. Vancomycin and Cefepime are started. What is the next step in management?
A. Immediate Surgical Consult and Clindamycin.
B. Draw labs to risk stratify via the LRINEC score and a CT scan
C. Immediate Surgical Consult and a CT scan.