Generalized pustular eruption associated with converting enzyme inhibitor therapy

A 67-year-old man presented with a high fever and a generalized rash. His extended hospital stay was characterized by fever with repeated staphylococcal bacteremia and the appearance of axillary lymphadenopathy and splenomegaly. Skin lesions became hyperpigmented, dry, and atrophic with areas of exfoliation and ulcers. Examination of skin and lymph node biopsy specimens showed findings consistent with mycosis fungoides. The patient unexpectedly recovered on discontinuation of captopril. A positive macrophage inhibiting factor response for bath captopril and enalapril indicated that the nonsulfhydryl moiety was the antigenic stimulant for the lesion resembling mycosis fungoides.