This 90 year old nursing home patient was evaluated for swelling of the tongue and diagnosed with angioedema. She was treated with oral steroids and went on to develop widespread truncal erosions with hemorrhage. Although some of the erosions healed with atrophic hypopigmented scars, lesions progressed for 2 months. When these images were taken she had a Nikolsky sign and was diagnosed with toxic epidermal necrolysis. She was given intravenous immunoglobulin without improvement. Skin biopsy showed an amorphous eosinophilic material deposited throughout the dermis. Congo red was positive, and green birefrigience was noted on polaroscopy consistent with bullous amyloid. She was transferred to the burn unit where she died of Gram negative sepsis a week later.
hemorrhagic bullae, erosions, and atrophic hypopigmented scars