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February 1, 2008

Hemorrhagic Bullae on the Hands—Quiz Case

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Arch Dermatol. 2008;144(2):255-260. doi:10.1001/archdermatol.2007.42-a

A 66-year-old man with hypertension presented with painful, raised erythematous lesions on the dorsal surface of both hands for 2 days. The lesions were preceded by a 1-week history of low-grade fevers, sore throat, and back stiffness. He was treated with methylprednisolone for 1 day by his primary care physician. The patient denied any other systemic symptoms or areas of affected skin. There was no exposure to new chemicals, medications, or detergents.

Physical examination revealed violaceous, hemorrhagic bullae on the dorsal aspects of both hands (Figure 1). They were raised, firm, and mildly tender. A skin biopsy specimen of the dorsal surface of the right hand was obtained (Figure 2 and Figure 3).

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