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JAMA Dermatology Clinicopathological Challenge
October 2016

Fixed Erythema on the Abdomen in a Hematologic Patient

Author Affiliations
  • 1Kempf und Pfaltz Histologische Diagnostik, Zürich, Switzerland
  • 2Kantonsspital Schaffhausen, Dermatologie, Schaffhausen, Switzerland
JAMA Dermatol. 2016;152(10):1159-1160. doi:10.1001/jamadermatol.2016.1534

A man in his 60s presented with a 2-month history of painful, occasionally pruritic, fixed erythema on the abdomen. In addition, the patient suffered from a splenic marginal zone lymphoma with bone marrow infiltration, had a history of splenectomy, and an IgM-κ paraproteinemia. His hematologic condition was considered stable by his physician, who had also been treating the patient for hepatitis C with ledipasvir-sofosbuvir for 3 months. On examination, there was a warm erythema on most of the abdomen, which appeared distended owing to hepatitis-induced ascites (Figure, A). Laboratory results showed an elevated but stable white blood cell count of 19.04 × 103µL (reference range, 3.6-10.5 × 103µL), a recent rise of C-reactive protein levels to 179 mg/L (reference range, 0-5 mg/L), as well as a rise of IgM levels from 1060 mg/dL to 2220 mg/dL (reference range, 34-248 mg/dL) within the past year. A biopsy procedure was performed on the abdomen (Figure, B-D).

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