A pustular predicament
WHEN a patient presents with multiple pustules like this, a serious infective process is often the first consideration. However, this patient did not feel unwell and was afebrile. The skin felt hot and tender. Pustules are predominantly composed of neutrophils, but these can be part of an inflammatory process. Pustules like this, on red and tender skin, are either a pustular drug eruption or generalised pustular psoriasis. In this case it was a pustular drug eruption due to azathioprine, which was in itself unusual.