Leukaemic vasculitis with myelodysplastic syndrome

摘要

A 75-year-old black woman with insulin-dependent diabetes and obesity presented in January, 2015, with a 10 day history ofpruritic lesions on her arms and legs, 2–3 months of night sweats, and 3 weeks of right-sided headache, sinus pain, and congestion. The skin lesions had developed while she was taking prednisone for presumed temporal arteritis. She had no associated fever, abdominal pain, diarrhoea, myalgia, or arthralgia. On examination she looked well. On the extensor elbows extending down her forearms bilaterally and on her knees and shins were dozens of 1–2 cm oedematous pink-red papules with a darker red-violet central zone, resembling atypical papular target lesions of erythema multiforme (fi gure). She had similar lesions on the knees and shins. Along Wallace’s lines on the medial aspect of her feet and the tips of her fi ngers and toes were about 20 red macules, 5–15 mm in diameter. She had one 2 mm erosion on the soft palate of her mouth; her face was otherwise spared.