[Skip to Content]
[Skip to Content Landing]
Views 2,951
Citations 0
JAMA Clinical Challenge
June 13, 2017

A Man With a Nonblanchable Purpuric Rash

Author Affiliations
  • 1Division of Immunology, Allergy and Rheumatology, Department of Internal Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio
  • 2Division of Nephrology, Department of Medicine, University of Toledo, Toledo, Ohio
  • 3Division of Rheumatology, Department of Medicine, University of Toledo, Toledo, Ohio
  • 4now with Division of Rheumatology, Department of Medicine, University of Michigan, Ann Arbor
JAMA. 2017;317(22):2329-2330. doi:10.1001/jama.2017.4954

A 71-year-old man presented with 4 weeks of a diffuse rash along with 1 week of bilateral elbow and knee pain. For the past year, he had recurrent episodes of diverticulitis complicated by colovesical fistula. Six weeks ago, he underwent sigmoid colon resection with fistula repair. He had no fever, abdominal pain, dysuria, or urinary frequency. He was prescribed prednisone when the rash first presented (starting at 30 mg/d and decreased by 10 mg every 4 days). The rash improved initially but recurred at the 10-mg/d prednisone dosing. Medical history included glaucoma, gastroesophageal reflux disease, and osteoarthritis. His home medications included lansoprazole, probiotics, vitamin B12, folic acid, vitamin D3, prednisone (10 mg/d), and timolol eye gel. He had no sick contacts or recent travel and reported no alcohol or tobacco use.

×