A 53-year-old female visited our office for dermatopathy of 'the right side of the trunk'. For one week prior to the appearance of the lesions she was feeling pain and 'a strange, creeping sensation' over the affected area. The patient had a known history of rheumatoid arthritis for which she was receiving medications, namely, methotrexate 10 mg p.o. once weekly and prednisolone 5 mg p.o. once daily. Five months prior to her visit she had a hospitalisation due to exacerbation of rheumatoid arthritis manifested by arthritis and pulmonary involvement. Throughout her childhood she suffered from uncomplicated mumps, chickenpox and pertussis.
The cutaneous eruption at the time of presentation had a dermatomal distribution extending from her right upper abdominal quadrant to her back and consisted of small vesicles coalescing to form plump-reddish plaques (Figures 1 and 2). Lesions were extremely tender on palpation. Lung auscultation revealed bilateral crackles at the lower fields, which, according to previous medical reports, were first noticed at her previous hospitalisation.