Race for the Case

Race for the Case is a clinical quiz feature published quarterly in DermWorld Directions in Residency — and right here!

Answer the questions below to enter. Looking for the Summer 2024 answers? Review them now. To submit cases and questions, email Dean Monti at dmonti@aad.org.

Diagnose this new case by Chiara Rosenbaum, DO, MS

A 60-year-old male with past medical history of diabetes mellitus type 2, deep venous thrombosis/pulmonary embolism, hypertension, pancreatitis, stroke, hyperlipidemia, and history of necrotizing fasciitis presented to the hospital with a chief complaint of blisters on his hands. The patient noticed new blisters on both hands a week prior, and he admits to associated pain and swelling of the bilateral hands. He denies pruritus or having blisters elsewhere on his body. The patient denied recent illness, travel, new medications, working outdoors or in hazardous conditions, or recent trauma to the hands. The patient reports taking a daily over-the-counter anti-inflammatory medication for pain associated with his chronic pancreatitis.

1. What is the most likely diagnosis?

2. How would you differentiate this condition from a similar inherited form?

3. Describe the classic histopathologic findings of this condition.

4. What is the relevant work-up for this condition?

5. What medication is most likely to have caused this patient’s episode?

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