A case of acne fulminans presenting with systemic symptoms resembling acute appendicitis with maculopapular purpura-like eruption exacerbated by systemic steroids


Address correspondence and reprint requests to: Glauco Cristofaro, MD, Clinical Fellow, Dermatology Unit, Department of Critical Care Medicine and Surgery, University of Florence, Piazza Dell'Indipendenza 11-50121 Florence, Italy, or email: drcristofg@gmail.com.


Acne fulminans, the most severe form of acne, comprises ulcerative nodulocystic lesions with general, abdominal, and skeletal symptoms acute in onset. In our case, the patient initially had been managed as acute appendicitis. Antibiotic therapy had been administered in full doses with systemic corticosteroids, usually recommended as primary treatment. Few days later, we observed the complete palette of clinical manifestations (vasculitis-like lesions and joint pain) and the classic signs (nodules and pustules on face and chest) allowing the correct diagnosis. Our treatment was peculiar: a systemic antibiotic therapy, based on cephalosporines, proved to be effective.