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JAMA Oncology Clinical Challenge
December 13, 2018

Erythematous Macular Eruption in an Older Woman

Author Affiliations
  • 1Department of Haematology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, Scotland
  • 2Department of Pathology, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, Scotland
  • 3Dundee Cancer Centre, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, Scotland
JAMA Oncol. Published online December 13, 2018. doi:10.1001/jamaoncol.2018.5317

A white woman in her 70s with advanced Alzheimer disease was referred to the hematology clinic for evaluation of a high hemoglobin level (169 g/L; normal range, 120-160 g/L) and red blood cell count (5.67 × 1012/L; normal range, 3.8-4.8 × 1012/L) as well as a generalized itch that was worse after a bath. On examination, she had a florid, erythematous macular eruption over the trunk and limbs (Figure, A) but no hepatosplenomegaly or lymphadenopathy. In addition to the high hemoglobin level, mild lymphocytosis (absolute lymphocyte count, 6.2 × 109/L, range 1.5-4.0 × 109/L) was noted with the lymphocyte morphology, suggesting reactive changes. Skin biopsy specimen (Figure, B) showed a normal epidermis with a pericapillary infiltrate of small lymphocytes restricted to the dermis and no leukocytoclastic vasculitis, fungal organisms, or dermal mucin. The absence of cellular atypia and epidermal involvement suggested a diagnosis of lupus, or gyrate or annular erythema, and the need for clinicopathological correlation.

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