Abstract
A 32-year-old female with a history of anxiety and irritable bowel syndrome presented to the emergency department with a painful, pruritic rash and malaise for the past 3 days. The rash started as a pruritic area on her neck, and quickly spread to the rest of her body. It consisted of diffusely scattered dark red edematous papules and vesicles as well as erosions, some coalescing into plaques on the chest, abdomen, back, and neck with a more scattered appearance of the face and extremities. There was sparing of the palms and soles. Medications included buspirone, venlafaxine, and propranolol, with no recent dose adjustments. The patient denied travel history, sick contacts, and arthropod bites. Initial labs were within normal limits, and extensive workup of infectious and neoplastic causes was unrevealing. Skin biopsy revealed cytotoxicity dermatitis with many mononuclear cells. There was exocytosis of many mononuclear cells into the epidermis, and the upper 2/3 of the epidermis was preferentially affected by cytotoxicity. Further history revealed the patient began using marijuana a couple days prior to the onset of her rash. She was treated with supportive care, and burn specialists and ophthalmology were consulted. The patient improved throughout her hospital stay. There is one reported case of CBD-oil induced Stevens-Johnson syndrome (SJS) in the literature. However, unlike SJS which affects the full thickness of the epidermis, this patient’s histopathology is unique and may be a new entity to consider.