7

Case 7


History



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.






images


Please describe what you see


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


Investigations


CBC:


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?


You may also need

Oct 23, 2019 | Posted by in GASTROENTEROLOGY | Comments Off on 7
Premium Wordpress Themes by UFO Themes