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).
Prieto-Barrios M, Ortiz-Romero PL, Rodriguez-Peralto JL. Leonine Facies, Flushing, and Systemic Symptoms. JAMA Dermatol. 2017;153(9):925–926. doi:10.1001/jamadermatol.2017.0746
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