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JAMA Clinical Challenge
August 20, 2014

Red Papules on the Tongue of a Patient With Hemiparesis

Author Affiliations
  • 1Department of Dermatology, Hsin-Chu Branch, National Taiwan University Hospital, Hsin-Chu
  • 2Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei
  • 3Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei
  • 4Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei
JAMA. 2014;312(7):741-742. doi:10.1001/jama.2014.1658

A 39-year-old woman had an acute onset of headache, increasing right-side hemiparesis, and numbness with fever. Computed tomography (CT) of the brain showed a ring-enhanced lesion with surrounding edema on the left frontoparietal lobe. Multiple red papules on the tongue (Figure 1), trunk, and limbs were noted during the physical examination. The patient stated she had not noticed the red papules before. There was no suggestion of otitis media or parasinusitis and no history of craniotomy, open head injury, or cyanotic heart disease. The patient did relate having many prior episodes of epistaxis since childhood. Blood cultures were obtained when the patient was first seen, and the patient received ampicillin/sulbactam empirically.

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