A Painful, Blistering Rash
A 67-year-old man presented with painful oral and skin lesions developing over the last 2 months. The lesions initially formed in his mouth and lips, and slowly spread to his torso, groin, and extremities (). The lesions began as blisters that broke easily and were exquisitely painful to light touch. In the past few days, he also developed painful lesions on his eyes that were associated with redness and photophobia. The patient saw his primary care doctor at the onset of illness and failed to improve with courses of azithromycin, ciprofloxacin, and tetracycline. He was no longer able to tolerate anything by mouth because of pain and he had lost a significant amount of weight. His skin exam was notable for Nikolsky’s sign.