18-Year-Old With Painful, Eroded Lesions

An 18-year-old man presented to urgent care with fever, pain in multiple joints, and a back rash that had been progressive for the last few weeks. On examination of the back, there were multiple painful erythematous and violaceous papules and nodules as well as several large pustules. Some of the lesions were eroded and crusted. The patient reported that he recently started an intensive bodybuilding regimen with a 3 month use of anabolic-androgenic steroid/testosterone prior to lesion presentation.

View the image above and consider what your diagnosis and next steps would be. Resolution of the case is described on the following page.