Author: Benjamin Saben, MD
Editor: Young Yoon, MD
A 22 year old male football player got a colored tattoo over his left shoulder. One month later, he developed pruritic red bumps on his left upper arm, elbow, and right upper arm. The rash then spread to his chest, upper back, and face. The patient noticed that his rash was worse in the sun. He also noted that his skin cracked at the nail beds and at the corners of his mouth. He developed gum bleeding with tooth-brushing, pain and swelling in his hands with weight-lifting, and difficulty with gripping. He reported low back pain, shoulder pain, and fatigue. He developed red bumps on his knuckles, and his hair started to fall out. He noted a 10 lbs weight loss.
The patient presented to an urgent care clinic for evaluation, and he was diagnosed with an allergic reaction. He received prednisone for 3 days, which improved his symptoms. However, the rash recurred when he stopped his prednisone. Ultimately, he was treated with 3 courses of steroids, each giving him temporary improvement but never resolution of his symptoms.
BP 130/86, HR 108, R 18, T 98.4 Ht 5'6" Wt 163 lbs
Gen: Comfortable African-American male NAD with moon-facies
Skin: Malar rash. Tattoos left upper arm and right arm. Red papules bilateral upper arms and extensor surface of elbows. Red patches on torso and abdomen with excoriations / streaks Case Photo #1, Case Photo #2, Case Photo #3, Case Photo #4
HEENT: Fissuring at corners of his mouth
Neck: No lymphadenopathy
Chest: RRR no murmurs. Lungs clear bilaterally
Abdomen: Soft, nontender, no organomegaly
Extremities: Cracking and fissuring at nail beds. Mild swelling at MCPs. Dorsal MCPs with red scaly macules
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