Case 7


A 54-year-old gentleman who drank half a bottle of vodka daily for over 20 years presents with severe epigastric pain and a bilateral lower limb violaceous skin rash for 1 week. This is associated with fever and confusion.

Physical examination

Temperature 38.2°C, pulse 120 bpm, BP 120/78mmHg, SaO2 95% on RA.

Hydration on the dry side.

Examination of the hands reveals no clubbing, palmar erythema and a hepatic flap.

Head and neck examination is unremarkable.

Cardiovascular: HS dual, no murmur.

His chest is clear on auscultation.

Abdominal examination reveals a central tenderness, but no guarding/rebound tenderness.

GCS 14/15 with confused speech and disorientation; otherwise there is no focal neurological deficit detected.

Mild lower limb oedema is noted.

Figure 7.1 is a clinical photo of his lower limb rash.


Please describe what you see

A violaceous, slightly indurated, tender maculopapular rash has developed over his lower limbs.



WBC 33 x 109/L;

haemoglobin 12g/dL;

platelets 255 x 109/L.

Amylase 1058 IU/L.

Liver and renal function tests are normal.

International Normalised Ratio is normal.

What are the potential causes for the skin lesions?

Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 7

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