A 45-year-old woman presents with acute erythroderma involving 95% BSA of 3 weeks duration. She has tachycardia (118/min), bounding pulses, and warm extremities. Echocardiography is normal. Which complication is most likely responsible for her cardiovascular findings?

• A Myocarditis due to drug-induced hypersensitivity
• B Septicemia secondary to Staphylococcus aureus colonization
• C Constrictive pericarditis from underlying lymphoma
• D High-output cardiac failure due to cutaneous vasodilation ✓

Explanation

Erythroderma causes massive cutaneous vasodilation with decreased systemic vascular resistance. This creates a hyperdynamic circulation with bounding pulses and tachycardia, leading to high-output cardiac failure, especially in elderly patients. The normal echocardiography rules out structural heart disease. This is a well-recognized hemodynamic complication of exfoliative erythroderma requiring careful fluid management.

Reference: Rook's Textbook of Dermatology, 9th ed.

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