Generalized red rash.

Volume 85, Number 3 www.aafp.org/afp American Family Physician 271 A 50-year-old woman presented to the emergency department with a diffuse rash that appeared four months earlier. The rash began on the upper extremities and gradually spread to her entire body. It was pruritic and associated with subjective fever and chills. Some of the lesions were pustular and crusting. She did not have a history of skin problems, and she had not been exposed to any new body creams, medications, detergents, or foods. The patient also noted a lump in her right breast at the same time the rash appeared. She had not seen a physician previously for the lump. She had a significant history of tobacco use and a family history of breast cancer in an aunt. On examination, her blood pressure was 176/84 mm Hg, and her pulse was 113 beats per minute. The breast examination revealed a 3-cm, firm mass in the right outer quadrant that was fixed to underlying structures. There were peau d’orange changes surrounding the areola and a single palpable right axillary lymph node. She had generalized erythema and desquamation of the scalp, face, chest, back, and extremities with crusting and weeping of the skin surface (see accompanying figure). No lesions were noted on the palms or soles.