A previously healthy 58-year-old woman presented to the emergency department with a 4-day history of a rapidly progressive generalized skin eruption. One week before, she was started on oral nystatin. On physical examination, she was afebrile, tachycardic, and hypotensive. She had generalized erythema with confluent pustules, pronounced in the intertriginous areas, including the axilla, creases of the elbow, inguinal folds, and medial thighs (Figure 1 A and B). Laboratory evaluation showed a leukocytosis with neutrophilia, elevated creatinine, and elevated lactate.
