Intended for healthcare professionals

Endgames Case Review

A postpartum eruption

BMJ 2017; 356 doi: (Published 09 March 2017) Cite this as: BMJ 2017;356:j968
  1. Nadia Shad, foundation year 2 doctor1,
  2. Masud Haq, consultant physician2,
  3. Dennis J Barnes, consultant physician2
  1. 1University Hospital Lewisham, London, UK
  2. 2Tunbridge Wells Hospital, Tunbridge Wells, UK
  1. Correspondence to N Shad Nadia.shad{at}

A 40 year old woman (gravida 2, para 2) presented to the emergency department nine days postpartum with a four day history of progressive pruritic rash. The rash had initially appeared peripherally on the limbs and later progressed to involve the trunk, abdomen, and back. The palms of the hands and soles of the feet were spared, and there was no mucosal involvement. She had no medical history and was not taking any medication. A previous HIV test and herpes simplex virus titres had been negative. She had presented following a spontaneous delivery after an uneventful pregnancy.

On examination, she had numerous tense fluid filled blisters affecting her hands, feet (fig 1), and flexor and extensor aspects of all limbs. Diffuse erythematous pruritic plaques were also present over her torso. Some blisters had burst due to positional pressure, however, Nikolsky’s sign was negative.

Fig 1

Tense bullae with surrounding erythema over flexural aspect of the lower limbs (coated in calamine lotion due to severe pruritus)


  • 1. What are the differential diagnoses and how are they investigated?

  • 2. What is …

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