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JAMA Dermatology Clinicopathological Challenge
September 2017

Leonine Facies, Flushing, and Systemic Symptoms

Author Affiliations
  • 1Department of Dermatology, Hospital Universitario 12 de Octubre, I+12 Research Institute, Universidad Complutense, Madrid, Spain
  • 2Department of Pathology, Hospital Universitario 12 de Octubre, I+12 Research Institute, Universidad Complutense, Madrid, Spain
JAMA Dermatol. 2017;153(9):925-926. doi:10.1001/jamadermatol.2017.0746

A man in his 50s with a history of both hypertension and a pulmonary tumor that was resected 10 years earlier (Figure, A) presented with generalized phymatous changes affecting his entire face, as well as a few pustular lesions and a diffuse erythema that gave him an appearance of leonine facies (Figure, B). He complained of substantial, progressive seborrheic hyperplasia and flushing episodes over the past year, accompanied by ocular manifestations that included swelling of his eyelids. Ophthalmological examination showed features of chronic blepharitis and lagophthalmos. Detailed anamnesis revealed a history of intense diarrhea in prior months. A biopsy specimen from the skin of the forehead was obtained and analyzed under hematoxylin-eosin staining (Figure, C). A computed tomography (CT) scan completed the etiological investigation (Figure, D).

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