A 45-year-old man, previously healthy, was referred from the Emergency Department to the Rheumatology Service of the Lucs Hospital and Trudeau, with a two-week history of progressive lesions, characterized by appearance.
The patient's medical history only highlighted a history of recurrent eruption of the trunk from 18 years of age, characterized by asymptomatic erythematous papules in the predetermined region and arms.
She had no history of herpetic skin or genital infections or familial skin diseases.
On physical examination, the patient was in regular general condition, afflicted and presented multiple papules and umbilicated pustules on the trunk, confluent, with some lesions in the crust stage.
No lesions on the face, genitals or mucosae.
The presence of flattened papules skin on the back, palm pits and alternation of red and white lines on the nails stood out in the hands, suggestive findings of Darier's disease.
She was hospitalized with a presumptive diagnosis of herpetic eczema and Darier's disease.
General examinations, current culture and polymerase chain reaction (PCR) for herpes simplex virus of the pustules, and a biopsy of skin lesions suggestive of Darier's disease were performed.
Empirically, treatment was indicated with oral paste 400 mg 5 times a day and cloxacillin ev 1 g every 6 hrs, which was maintained for 10 days.
A normal blood count, ESR 29 mm/h, CRP 123 mg/L, GGT 108 U/L were found among the general tests. VDRL results and serology for HIV and HBV were negative.
The skin culture was positive for Staphylococcus aureus resistant only toclindamycin and eHS, and the PCR in real time, performed at the Virology Laboratory of the Institute of Biomedical Sciences of the School of Chile V.
Histopathological findings of skin biopsy were compatible with Darier's disease.
The patient responded quickly to treatment and was discharged after 10 days.
