LAUSR

CASE REPORT A man in his 40s with morbid obesity, hypertension, depression/anxiety, and psoriasis presented with an acute, rapidly progressive skin eruption. His preexisting psoriasis had been present for years, with minimally symptomatic transient plaques managed with emollients. His medications included lisinopril and bupropion, which were started 1 month earlier. He received Pfizer vaccine (first dose) 5 days before the development of the rash, with no recent illnesses or new medication exposures. The rash began with tender, erythematous patches and plaques on his abdomen and arms, with progression to his legs and buttocks. Two days after onset, an immediate care clinic diagnosed a yeast infection and prescribed fluconazole 100 mg orally (1 dose taken) and nystatin cream. The following day, he had significantly more surface area involvement of rash with worsening malaise, and upon presentation to the emergency department, he was prescribed prednisone 50 mg/d (0.3 mg/kg/d; patient’s weight, 172.36 kg) and doxycycline 100 mg twice a day and given 1 dose of intravenous methylprednisolone 125 mg. The tick-borne illness panel was negative, and he was instructed to discontinue lisinopril and bupropion. With worsening cutaneous and systemic symptoms, the patient presented to the dermatology