An 84-year-old man with dementia presented to a dermatology clinic with a 1-week history of multiple dark violaceous nodules on his right leg and foot. The patient had no fevers, night sweats, fatigue, weight loss, or leg pain or swelling, and no recent history of trauma. Nine months prior to presentation, he had been diagnosed with bullous pemphigoid, which was initially treated with oral prednisolone (40 mg daily for 1 week). His prednisolone dose was reduced by 10 mg per day each week to 10 mg daily, which he had been taking for 8 months. On presentation, his temperature was 36.7 °C (98.1 °F); blood pressure, 120/85 mm Hg; and heart rate, 92/min. Physical examination revealed multiple round, dark brown to violaceous-colored firm nodules on his right leg and 2 nodular masses with hemorrhagic crusts on his right foot (Figure 1). The right dorsalis pedis and popliteal artery pulses were normal to palpation. Laboratory testing revealed a normal complete blood cell count and normal creatinine and liver function test results; results of HIV antibody testing were negative.
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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: Chen-Yi Wu, MD, PhD, Department of Dermatology, Taipei Veterans General Hospital, No. 201, Sec.2, Beitou Dist, Taipei, Taiwan 11217 (firstname.lastname@example.org).
Published Online: November 20, 2023. doi:10.1001/jama.2023.20118
Conflict of Interest Disclosures: None reported.
Additional Information: Drs Chen and Chuang contributed equally to this work. We thank the patient’s son for providing permission to publish the patient’s 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:
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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