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Pruritic Rash in a Woman With Endometrial Cancer

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

A woman in her 60s presented for evaluation of a new pruritic rash. The rash initially developed on the patient’s legs 13 days before presentation and subsequently progressed to her feet, arms, hands, and trunk. Associated symptoms included a burning sensation and occasional pain. Her medical history was notable for endometrial adenocarcinoma status post hysterectomy and recent postoperative radiotherapy (total of 50.4 Gy in 28 fractioned doses), which was completed 4 days after the onset of the rash. She denied any new medications or exposure to chemotherapy, imaging with intravenous contrast, or recent travel. The remainder of her review of systems was unremarkable. On physical examination, there were numerous erythematous edematous coalescing papules and plaques on the upper and lower extremities and scattered erythematous papules and plaques on the back and buttocks (Figure, A). Some plaques were annular and polycyclic in configuration, with central hyperpigmentation (Figure, B). Her chest, abdomen, face, and oral mucosa were clear. A complete blood cell count was notable for an eosinophilia of 11%, with an absolute cell count of 0.80 ×103/uL. Results from a comprehensive metabolic panel were normal. A biopsy was performed on her right thigh for histopathological examination.

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A woman in her 60s presented for evaluation of a new pruritic rash. The rash initially developed on the patient’s legs 13 days before presentation and subsequently progressed to her feet, arms, hands, and trunk. Associated symptoms included a burning sensation and occasional pain. Her medical history was notable for endometrial adenocarcinoma status post hysterectomy and recent postoperative radiotherapy (total of 50.4 Gy in 28 fractioned doses), which was completed 4 days after the onset of the rash. She denied any new medications or exposure to chemotherapy, imaging with intravenous contrast, or recent travel. The remainder of her review of systems was unremarkable. On physical examination, there were numerous erythematous edematous coalescing papules and plaques on the upper and lower extremities and scattered erythematous papules and plaques on the back and buttocks (Figure, A). Some plaques were annular and polycyclic in configuration, with central hyperpigmentation (Figure, B). Her chest, abdomen, face, and oral mucosa were clear. A complete blood cell count was notable for an eosinophilia of 11%, with an absolute cell count of 0.80 ×103/uL. Results from a comprehensive metabolic panel were normal. A biopsy was performed on her right thigh for histopathological examination.

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Article Information

Corresponding Author: Sydney E. Liang, MD, Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 E 38th St, 12th Floor, New York, NY 10016 (sydney.liang@nyulangone.org).

Published Online: February 8, 2023. doi:10.1001/jamadermatol.2022.6349

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank the patient for granting permission to publish this information.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

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