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Recurrent Erysipelas-like Erythema

Daiki Yokokawa, MD, Kiyoshi Shikino, MD, PhD, Sogai Daichi, MD,  Yuta Hirose, MD and Masatomi Ikusaka, MD, PhD

August 1, 2017

A 48-year-old Japanese woman with past medical history of eosinophilic gastroenteritis presented with a 4-month history of recurrent episodes of high-grade fever with abdominal pain and rash that occurred monthly with her menstrual period. The episodes were self-limited, lasting 1–2 days. She was asymptomatic between the episodes. The rash was non-tender; diffusely edematous and erythematous; and located on her limbs, palms, soles, and trunk, resembling erysipelas (Figs. 1-2). The erythema disappeared after applying finger pressure to the palm (Fig. 2, arrowhead). She had no significant family history. Her only medications were Rebamipide, Polycarbophil calcium, Hangeshashinto (herbal medicine), and acetaminophen for pain. She denied smoking and alcohol use. Laboratory tests showed leukocytosis (29,800/μL) with predominant neutrophilia (95%) [A1] and no eosinophilia or evidence of organ damage. Anti-nuclear antigen (ANA) test was negative.

MS--22602-Figure-1--RB-.jpg

MS--22602-Figure-2--RB-.jpg

What is the most likely cause of the patient's fever and skin lesion?

A. Cellulitis

B. Familial Mediterranean fever (FMF)

C. Scarlet Fever

D. Systemic Lupus Erythematosus (SLE)


Click here to view answer

References

  1. Soora R, Nicandri K. Familial Mediterranean Fever: An Unusual Case Presentation. J Pediatr Adolesc Gynecol 2015; 28:e193-5.
  2. Drenth JP, van der Meer JW. Hereditary periodic fever. N Engl J Med 2001; 345:1748-57.
  3. Raff AB, Kroshinsky D. Cellulitis: A Review. JAMA 2016; 316:325-37.
  4. Kavanaugh A, Tomar T, Reveille J, Soiomon DH, Homburger HA. Guidelines for clinical use of the antinuclear antibody test and tests for specific autoantibodies to nuclear antigens. American College of Pathologists. Arch Pathol Lab Med. 2000; 124:71-81.
  5. Allmon A, Deane K, Martin KL. Common Skin Rashes in Children. Am Fam Physician 2015; 92:211-6.
  6. Livneh A, Langevitz P, Zemer D, Zaks N, Kees S, et al. Criteria fot the diagnosis of familial Medeterranean fever. Arthritis Rheum 1997; 40:1879-85.


Author Information:

Daiki Yokokawa, MD, Sogai Daichi, MD, and Yuta Hirose, MD are a Clinical Fellow of the Department of General Medicine at Chiba University Hospital in Japan.

Kiyoshi Shikino, MD, PhD is Project Assistant Professor of the Department of General Medicine at Chiba University Hospital in Japan

Masatomi Ikusaka, MD, PhD is a Professor of the Department of General Medicine at Chiba University Hospital in Japan.

Conflict of Interest: The authors declare that they do not have any conflicts of interest.



 

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