An 83-year-old woman was admitted after the attending physician observed a blistering eruption on the lower area of her left leg (Figure 1). The eruption had developed over about 10 days and was associated with some deterioration in the patient's mental state; no pain or itching was reported. Her medical history included peptic ulcer disease and cellular-phase myelofibrosis. Laboratory investigations revealed a hemoglobin level of 10.9 g/dL (reference range [RR], 11.5-15.5 g/dL) and a mean corpuscular volume of 85.8 fL (RR, 80-96 fL), with a hematocrit of 32.5% (RR, 36%-45%) and a red blood cell count of 3.8 × 106/µL (RR, 3.9-5.0 × 106/µL). The neutrophil count was 18 200/µL (RR, 2000-7500/µL), and the results of the rest of the differential white blood cell count were un-remarkable. The platelets were normal in count and morphological appearance. The patient was currently being treated with monthly blood transfusions for recurrent myelofibrosis-induced anemia.
Ardern-Jones MR, James MP. Blistering Eruption on an Elderly Woman's Leg—Quiz Case. Arch Dermatol. 2004;140(4):479-484. doi:10.1001/archderm.140.4.479-g