Back issues No.3 - 2003 / Resident Forum  

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Symmetric Erythema in A Diabetic Patient
Jung-Yi Chan, Chia-Yu Chu
Dermatol Sinica 21: 300-301, 2003

A 54-year-old female patient, who has been diagnosed as having diabetes mellitus for more than 10 years without regular medical control, was transferred to our hospital due to active upper gastro-intestinal(UGI) bleeding and impending hypovolemic shock. Asymptomatic skin rashes developed symmetrically on the four extremities on admission. She had been treated with ampicillin/sulbactam for 4 days in another hospital for symptomatic pyuria. Erysipelas or cellulitis was suspected by the internal medicine doctors. On physical examination, she was afebrile. Several well-defined, palm-sized, erythematous patches distributed symmetrically on the forearms, dorsal hands, and legs with swelling were noted. There were also purpura and bulla formation on both shins(Fig.1, 2). The peripheral pulsations were all intact.
The hemogram revealed WBC: 6300/mm3. The erythrocyte sedimentation rate(ESR) level was within normal limit. The X-ray studies of the feet and hands did not reveal any destructive bone lesions.
A skin biopsy taken from the erythematous lesion on her left forearm(Fig. 3). revealed no remarkable epidermal change with solar elastosis and sparse inflammatory cells in the dermis microscopically. Many ectatic vessels were also noted in the dermis(Fig. 4). The skin lesions were gradually resolved two weeks later without active treatments.

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