Presenter: Christopher Mancuso, DO

Dermatology Program: Saint Barnabas Hospital

Program Director: Cindy Hoffman, DO

Submitted on: June 3, 2018

CHIEF COMPLAINT:  Rash on face and trunk

CLINICAL HISTORY: A 59yo female with diabetes and hypertension presents with an itchy and painful rash that began on the face and scalp and spread to body over the course of 2 months. Her rash began after sitting in the sun at her summer home in Pennsylvania. She reports a 40lb weight loss and denies fever, chills, nausea, vomiting, or arthralgias. Denies any new medications or recent illness. Has never had similar issues in the past. Previous treatment with topical steroids was moderately effective.

Allergies: None
Medications: Ramipril, Metformin, Hydroxyzine, Biotin, Vit D3
Social: Denies alcohol, tobacco, or illicit drug use

PHYSICAL EXAM:
•erythematous blanchable papules and plaques on back and B/L legs
•mild erythema of the face with slight scale
•no mucosal lesions

LABORATORY TESTS:

CPK 330 (HIGH)
-ALT/AST
-Aldolase
+ ANA (1:160 speckled)
– RF

DERMATOHISTOPATHOLOGY:

Vacuolar interface changes at dermoepidermal junction. Sparse mononuclear perivascular infiltrate. Scattered necrotic keratinocytes. Telangiectatic vessels.

DIFFERENTIAL DIAGNOSIS:

1.   Dermatomyositis
2.   SLE
3.   Photodrug reaction
4.   Allergic contact dermatitis
5.   Scleroderma