A 68-year-old man started on intravenous vancomycin for MRSA endocarditis develops pruritic tense bullae arranged in clusters over an erythematous base on his trunk and limbs, with some lesions forming rings. Biopsy shows a subepidermal blister with neutrophilic infiltrate. Which drug is the most common cause of this presentation?
- A Penicillamine
- B Phenytoin
- C Vancomycin ✓
- D Captopril
Correct answer: C. Vancomycin
Explanation
The annular clustered bullae described as a cluster of jewels or string of pearls with neutrophilic subepidermal splitting indicate linear IgA bullous dermatosis, and vancomycin is the most frequently implicated drug. Penicillamine causes pemphigus foliaceus-like disease, captopril can cause pemphigus, and phenytoin is linked to pseudolymphoma and SJS rather than linear IgA disease.
Reference: Rook's Textbook of Dermatology, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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