A 4 year old boy had a high grade fever for which he was given paracetamol. Amoxicillin was added after 2 days of fever as the fever was persistent. He was then admitted for an erythematous rash over his face and body on day 2 of amoxicillin. On day 2, the rash became pustular, involving mainly intertriginous areas, abdomen, back, neck, scalp and thighs, with severe pruritus. No joint pains/mucosal lesions noted. On examination, there were numerous tiny non-follicular pinpoint pustules noted over the body on an erythematous base. Systemic examination was normal. C-reactive protein is elevated along with mild neutrophilia and leucocytosis. Skin biopsy showed spongiform subcorneal and intraepidermal neutrophilic pustules along with papillary dermal edema, superficial lymphocytic infiltrate with neutrophils, and focal necrosis of keratinocytes.
