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A 67-year-old man receiving rituximab for membranous nephropathy was admitted to the hospital with volume overload. On initial physical examination, a large, nonblanchable, reticulated, hyperpigmented, gray-brown patch was observed on the patient’s mid and lower back (Figure). He had no pain, pruritus, or discomfort on this patch. He stated that his sister first noticed this patch several months prior to admission. On further questioning, he acknowledged using heating pads frequently for the past 40 years to relieve chronic back pain he has experienced since a motor vehicle crash in 1975. He denies any history of burns or thermal trauma as a result of heating pad use.
Bae E, Cohen JM, Grudberg SC. Hyperpigmented Reticulated Patch in an Older Man. JAMA. 2016;315(7):699-700. doi:10.1001/jama.2015.17693