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JAMA Surgery Clinical Challenge
February 2014

Diffuse Ulcerated Skin Rash

Author Affiliations
  • 1Department of General Surgery, Division of Surgical Oncology, Rambam Health Care Center, Haifa, Israel
JAMA Surg. 2014;149(2):209-210. doi:10.1001/2013.jamasurg.273

A 66-year-old man presented with a skin rash on his lower limb. He has been unemployed and bedridden for the last 3 years owing to his skin disease. He has a history of ischemic heart disease, familial Mediterranean fever, and arthropathy. He was treated with nonsteroidal anti-inflammatory drugs for pain relief and steroids for the skin disease. Except for the skin rash, he was newly diagnosed as having diabetes mellitus. On presentation, he noted anorexia and reported a 10-kg weight loss during the last 8 months. On physical examination, he appeared cachectic. His abdomen was soft with no palpable mass. A macular rash with multiple infected ulcerated areas and diffuse lower limb edema was noticed (Figure 1). The remainder of his physical examination results were unremarkable.