A man in his 80s presented to the emergency department with a 4-week history of progressive weakness and fatigue, with associated development of purple bruiselike lesions on his head. He denied any history of trauma, falls, or occlusive headgear use. His medical history was significant for atrial fibrillation, receiving anticoagulation medication, and heart failure.
On physical examination, numerous nontender violaceous plaques were seen on the forehead and scalp of the patient (Figure, A). On full skin examination, nonspecific skin-colored plaques were noted on the chest, and a 1.8 × 2.5-cm erythematous plaque was noted on the left lower back. There was no appreciable lymphadenopathy or hepatosplenomegaly. Peripheral blood test results revealed a hemoglobin level of 9.1 g/dL, a platelet count of 68 × 103/μL, a white blood cell count of 2800/μL, and an absolute neutrophil count of 1.0/μL. Lactate dehydrogenase level was 202 U/L. (To convert hemoglobin to g/L, multiply by 10.0; platelets to ×109/L, by 1; white blood cell and neutrophil counts to ×109/L, by 0.001; and lactate dehydrogenase to μkat/L, by 0.0167.) A 4-mm punch biopsy was performed on the erythematous plaque on the left lower back (Figure, B and C).
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Sophie Diong, MB BCh BAO (Hons), Dermatology Department, St James’s Hospital, James St, Dublin D08 NHY1, Ireland (email@example.com).
Published Online: May 24, 2023. doi:10.1001/jamadermatol.2023.1083
Conflict of Interest Disclosures: None reported.
Additional Contributions: We thank the patient for granting permission to publish this 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.
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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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