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JAMA Dermatology Clinicopathological Challenge
September 13, 2017

Generalized Netlike Erythema and Stroke in a Young Female

Author Affiliations
  • 1Eisenhower Medical Center, Rancho Mirage, California
  • 2Department of Dermatology, University of Lübeck, Lübeck, Germany
JAMA Dermatol. Published online September 13, 2017. doi:10.1001/jamadermatol.2017.3337

A woman in her 40s presented with a 4-hour history of ataxia and left-sided hemidysesthesia. Annular patches of violaceous erythema forming an irregular net-like pattern were noted on her trunk and extremities (Figure, A and B). The patient stated that these skin changes had appeared 2 years prior. Her medical history was significant for 5 strokes over the past 6 years and Raynaud syndrome for the past 2 years. In the past, despite extensive workup, no definitive diagnosis had been established. Complete blood cell count, liver function tests, creatinine, C-reactive protein, erythrocyte sedimentation rate, and urinalysis results were normal. Antinuclear antibodies and complement C3 and C4 levels were unremarkable. Antiphospholipid antibody and lupus anticoagulant screening results were repeatedly negative and no evidence of thrombophilia was found. Magnetic resonance imaging showed acute dot-like diffusion anomalies in the medial and posterior cerebral artery-supplied areas, as well as old stroke residues (Figure, C). Transesophageal echocardiography showed no abnormalities. A skin biopsy sample was taken from the patient’s left thigh (Figure, D).

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