Course: Purpuric Edematous Nodules and Plaques in an Immunosuppressed Older Man

CME Credits: 1.00

Released: 2021-05-19

A man in his 80s with a history of asthma and bronchiectasis who was receiving immunosuppression therapy presented to an outside hospital with dyspnea and right arm swelling and tenderness 8 days before transfer to our center. The immunosuppression therapy consisted of methylprednisolone, 12 mg every other day, and the patient’s medical history included cerebrovascular accident, atrial flutter, and aortic stenosis.
On initial evaluation, his vital signs were stable. On physical examination, the patient had edema of the right arm, hand, and fingers with overlying diffuse violaceous nonblanching and edematous nodules (, A). Purpuric plaques were also noted on the right cheek, central chest, left arm, and left posterior shoulder. Laboratory findings were significant for a hemoglobin level of 8.6 g/dL (reference range 13.5-17.5 g/dL [to convert to g/L, multiply by 10]). Results of blood cultures from the outside hospital showed “yeast” at the time of transfer.

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

View Full Course