A 64-year-old woman presents to your dermatology office for the evaluation of a rash. The rash comes and disappears on her face and groin. She went to the urgent care center and was prescribed prednisone tablets for allergic dermatitis. She was started on metformin a month ago for diabetes. She lost 4 pounds in one month. Her current medications include metformin for diabetes, prednisone for skin rash, hydrochlorothiazide and metoprolol for hypertension. A review of systems reveals diarrhea and depressive thoughts. On physical examination, you notice an erythematous rash with red plaques of annular shape with central blistering and bulla formation on her face and in the groin area. Her fingertips are red, shining, and erosive. A CT scan of the abdomen demonstrated a mass in the tail of the pancreas. This blistering disease is associated with which of the following systemic disorders?
