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Recurrent mucosal erosions and violaceous patches

Year: 2020

Type: article

Abstract: A 63-year-old man with coronary artery disease and end-stage renal disease on hemodialysis developed violaceous patches and mucosal erosions 24 hours following an admission for a cardiac evaluation, which included computed tomography angiography. He had a history that was significant for 4 similar, though less extensive, episodes, each following cardiac procedures with iodinated contrast and treated with supportive care. The patient noted facial involvement and mucositis with each previous episode. Examination revealed a well-appearing man in no acute distress with violaceous, circular patches, many with an erythematous border, on the face, buttocks, hands, and feet, as well as erosions on the oral and genital mucosae (Figs 1, 2). Review of systems was negative for fever, chills, malaise, weight loss, ocular pain, arthralgias, myalgias, shortness of breath, cough, or dysphagia. A punch biopsy specimen was obtained from the periphery of a representative lesion on the buttocks and histopathologic evaluation was performed with hematoxylin-eosin staining (Fig 3). The patient recovered over the course of 2 weeks following hemodialysis and oral prednisone.Figure 2Figure by Tyler J. Willenbrink, MD, Emily D. Henkel, BA, Brett H. Keeling, MDView Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Figure by Tyler J. Willenbrink, MD, Emily D. Henkel, BA, Brett H. Keeling, MDView Large Image Figure ViewerDownload Hi-res image Download (PPT) What is the most likely diagnosis?A.Stevens-Johnson syndrome (SJS)B.Erythema multiforme (EM)C.Generalized fixed drug eruption (FDE)D.Mycoplasma pneumonia-induced rash and mucositis (MIRM)E.Paraneoplastic pemphigus (PNP) Click here to view disclosures, take the quiz, and claim CME credit.

Source: JAAD Case Reports

DOI: 10.1016/j.jdcr.2020.06.046

Authors: Tyler J. Willenbrink, Emily D. Henkel, Brett H. Keeling

Institutions: The University of Texas System, The University of Texas at Austin, The University of Texas at San Antonio Health Science Center

Language: English

Topic: Drug-Induced Adverse Reactions

Subfield: Pharmacology (medical)

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $600