Recurrent Skin Rash in a 61 Year Old Housewife (2006)September 2006
Issue 1, Vol. 1
Jan Gutermuth1,2, Susanne Haug3, Markus Ollert1, Ulf Darsow1,2, Johannes Ring1 & Thilo Jakob1,2
1Department of Dermatology and Allergy Biederstein, Technical University Munich (TUM)
2Division of Environmental Dermatology and Allergy GSF/TUM and ZAUM - Center for Allergy and Environment TUM
3Allergy Unit, Department of Dermatology, University Hospital Zurich, Switzerland
J.G. and S.H. contributed equally to the publication
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Reason for Consulting
Heidi, a 61 year old housewife, was referred from the department of orthopedic surgery for workup of a skin rash in the context of preoperative screening. She suffered since 3 months from recurrent red spots on the lower extremities. Therefore, colleagues from the referring department raised the suspicion of an underlying infection as a potential contraindication for elective menisectomie.
Multiple erythematous macules and papules on the lower extremities
Heidi’s medical history revealed autoimmune thyroiditis, treated with levothyroxin over 9 years, arterial hypertension treated with bisoprolol for 6 years and hyperlipidemia treated with pravastatin since 2 years. Additionally, she suffered from coronary heart disease and had been on 100 mg acetylsalicylic acid (ASA) for the last 9 years after coronary stent implantation. She denied asthma, hay fever, atopic eczema or other allergic diseases.
Clinical examination showed multiple erythematous and hyperpigmented macules and papules on the dorsum of the feet, lower- and upper legs (Figure 1A/B). The remaining integument and further clinical examination showed no pathological findings.
* Which diagnosis do you propose? *