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.
Chiu H, Lin S. Red Papules on the Tongue of a Patient With Hemiparesis. JAMA. 2014;312(7):741-742. doi:10.1001/jama.2014.1658