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Internal Medicine Flashcard|Articles in Press

Sudden erythematous cutaneous eruption

Published:March 11, 2023DOI:https://doi.org/10.1016/j.ejim.2023.03.007
      A 43-year-old male with a history of hypertension, diabetes and obesity (BMI > 55) presented to the Emergency Department with a pruritic palpable rash for several days. It had started suddenly as erythematous wheals on the inguinal folds and spread turning into a generalized purpura, with a clear predominance on the distal aspect of legs. The presence of subcutaneous edema was impossible to assess, and no other primary lesions were present on skin or mucous membranes. The rash associated intense pruritus and general fatigue without fever. Upon thorough anamnesis, the patient reported having felt oscillating abdominal discomfort and diarrhea since 14 days earlier, which was attributed to the ingestion of spoiled processed cheese products, and in the last 24 h also slight lumbar pain and mild arthralgias in his hands. No new medications had been initiated on the months before the onset. Laboratory tests showed normal platelets and coagulation parameters. Kidney function was deteriorated (serum creatinine was 1.76 mg/dl [0.7–1.3] coming from prior normal range values) and urinalysis showed hematuria and intense proteinuria below nephrotic-range.
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