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JAMA Clinical Challenge
February 16, 2016

Hyperpigmented Reticulated Patch in an Older Man

Author Affiliations
  • 1Boston University School of Medicine, Boston, Massachusetts
  • 2Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
  • 3Department of Medicine, Boston VA HealthCare System and Harvard Medical School, Boston, Massachusetts
JAMA. 2016;315(7):699-700. doi:10.1001/jama.2015.17693

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.

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