Issue: 2018 > December > photo quiz

Crusted cutaneous lesions requiring early diagnosis and appropriate treatment

M. Dumas, L. Blum, E. Bégon, P. Brazille, M. Develoux, A. Moreno-Sabater, C. Bachmeyer
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A 71-year-old woman with a medical history of breast cancer but lost to follow-up was admitted to the hospital for fatigue, loss of autonomy and pulmonary infection treated with cefotaxime. On clinical examination, she was cachectic with a temperature of 38°C. Asymptomatic crusted lesions with fissuring were present over her extremities, in particular, on her feet, including the nails and legs (figure 1), and on her hands at the interdigital webspaces (figure 2); however, she presented with no scalp or mucosal lesions. Blood cell count, serum creatinine level and urinalysis, liver function tests, thyroid-stimulating hormone were within normal range; serum electrophoresis showed an albumin level of 15/l (normal > 35), C reactive protein was 67 mg/l (normal < 5) and HIV testing was negative.


See page 451 for the answer to this photo quiz.