Cystic acne with ulcerating lesions, fever, myalgia, and hepatosplenomegaly.

• A. Acne fulminans
• B. Pyoderma Faciale
• C. Acne vulgaris
• D. Rosacea

Answer: (A)

This presentation is classic for acne fulminans. When cystic acne is accompanied by ulcerating nodules plus systemic symptoms like fever, myalgia, and an enlarged liver and spleen, it signals a severe inflammatory reaction beyond ordinary acne. Acne fulminans is a rare, emergency-type complication that can involve systemic inflammation and constitutional symptoms, not seen with typical acne.

Why this is the best fit: the other conditions explain isolated facial redness or localized pustules without systemic illness. Acne vulgaris is the everyday form with fewer systemic signs. Rosacea and its fulminans variant (pyoderma faciale) involve facial redness and inflammatory lesions but typically lack the marked systemic features (fever, hepatosplenomegaly) described here.

Management revolves around controlling the inflammatory storm with systemic corticosteroids (for example, a high-dose prednisone course) and antibiotics to cover secondary infection. Isotretinoin, if considered, is usually postponed during the acute phase and reintroduced later only after stabilization. Hospitalization is often needed for monitoring and supportive care.