Clinical Images

Unusual Skin Rash

Submitted by: 

Rosie Lehmann
Resident in Emergency Medicine
Christiana Care

A 71 year old woman presented to the Emergency Department with left hip pain after a fall. Imaging (CT and ultrasound) revealed a mildly displaced left trochanteric fracture as well as a left tibial and peroneal DVT.  On exam she was found to have left lower extremity lesions, which she first noticed about 6 weeks prior to presentation.  She reported tripping about 4 weeks ago and scraping the lesions, at which point they got larger and developed dark scabs.  She described them as non-painful, but sometimes itchy.

Skin exam demonstrated 8 round lesions over her left lower anterior leg.  They ranged in size from about 1.5cm - 3cm in diameter. The lesions were confluent and raised from the skin, with erythematous plaque in between, but no surrounding erythema. The lesions were pale pink on the edges and became progressively more red towards the centers.  Some lesions had central necrosis with black or yellow eschar.  There was a blister-like appearance to the lesions, though they were firm and did not appear to be fluid-filled.  There was no associated warmth or tenderness.