Presenter: Christine Ku, DO PGY2; Michael Hohnadel DO; Rick Lin DO; Michael Sedrak MD. Dermatology Program: South Texas Dermatology Residency Program, Bay Area Corpus Christi Medical Center Program Director: Rick Lin, DO MPH
Submitted on: August 8, 2019
CHIEF COMPLAINT: ¨I have a rash and other lesions on my fingers”
CLINICAL HISTORY:
Signs and symptoms: The patient is a 23-year-old female who presented to the clinic with a complaint of diffuse skin rash and ulcerations. She reported symptom onset about 12 months ago, with worsening of symptoms in the past 4-6 months. Symptoms began with cuticle inflammation consisting of redness and pain. She saw her primary care physician who prescribed topical therapy with some improvement. A few weeks later she noted wrist pain and swelling followed by the progressive development of diffuse arthralgia and arthritis in fingers, hands, and knees. The patient then described onset of a rash over thighs and buttocks which then spread to her torso and extremities. She described the rash as pruritic and slightly painful. This was followed by the development of skin ulcerations resulting in open, non-healing wounds on extremities as well as digital ulcers on hands and oral ulcers. Of note, the patient also reported an unintentional weight loss of 20 pounds over the past year (over 15% of her initial body weight). The patient denied fevers, change in vision, shortness of breath or chest pain, or other systemic symptoms. The patient was evaluated by rheumatology who trialed prednisone, methotrexate injections, and Plaquenil with some improvement in symptoms. The patient had no other significant medical or surgical history, was previously not taking any medications. It was noted that she had a positive family history of lupus in her maternal aunt and cousin