Clinical Poll: Widespread, Painful Blisters in a 39-Year-Old
A 39-year-old man with no significant past medical history was admitted with severe, widespread, painful, flaccid blisters covering more than 60% of his total body surface area. The blisters initially had started on his torso but subsequently had spread to his mouth and distal extremities. Physical examination findings were notable for markedly elevated blood pressure, as well as desquamated, honeycombed lesions involving the torso, face, back, and all proximal and distal extremities, with positive Nikolsky sign. Oral examination revealed multiple flaccid blisters and buccal mucosal erosions bilaterally. There was 2+ pitting lower-extremity edema bilaterally up to the mid tibia. The right lower extremity was tender to palpation, and its diameter was approximately 2 cm larger than the left lower extremity. What should your next step be?