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September 1989

Fever and Painful Plaques on the Face, Back, and Extremities

Author Affiliations

Hospital Universitario San Carlos, Madrid, Spain

Arch Dermatol. 1989;125(9):1265-1266. doi:10.1001/archderm.1989.01670210103020

REPORT OF A CASE  A 63-year-old man presented to the emergency room with a 1-week history of fever, severe malaise, and cutaneous eruption. At admission, his temperature was 39°C and there were tender, warm, bluish-red, indurated plaques on his face, upper back, neck, and arms. The plaques had a sharp border and superficial vesicles and were purpuric in areas (Figs 1 and 2). Mucous membrane lesions were not present. Laboratory studies disclosed the following values: hematocrit, 0.315; erythrocyte count, 3.79 × 1012/L; leukocyte count, 3.5 × 109/L; and platelet count, 78.0 × 109/L, both with abnormal morphologic features. Chest and abdomen roentgenograms showed only unspecific changes. Cultures from blood and urine were negative. A cutaneous biopsy specimen exhibited an intense dermal inflammatory infiltrate, mainly composed of neutrophils, with no histologic evidence of vasculitis (Figs 3 and 4). A bone marrow aspirate and biopsy showed

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