Oval Annular Erythematous Plaques with Violaceous Centre

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Oval Annular Erythematous Plaques with Violaceous Centre

Postby Bilal Dar » Sat Apr 25, 2015 3:22 pm

A few days ago a young boy of twenty came to me with his mother complaining of fever and loss of weight since two to three weeks time and told me that he also had three rashes on his body. Two days ago when I saw the lesions looked to me like eczema in healing phase with scab formation over the lesion but yesterday boy came back to show me formation of reddish halo around the lesion and I noticed a papule formation in the center of lesion ; to my surprise all three lesions presented with the same picture , two lesions on the trunk on lateral side of body and one in the groin left thigh. His routine tests showed TLC raised to 12.6 and ESR 62 with slight elevation of LFT , bilirubin was normal.

Diagnosis ?
Attachments
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Groin: left side (1 lesion)
11173587_363135667205838_1690299846_n.jpg (68.56 KiB) Viewed 7269 times
11166088_363135917205813_2145239833_n.jpg
Trunk: right side (2 lesions)
11166088_363135917205813_2145239833_n.jpg (44.41 KiB) Viewed 7269 times
Bilal Dar
 
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Re: Oval Annular Erythematous Plaques with Violaceous Centre

Postby CFH » Sat Apr 25, 2015 5:30 pm

The lesions are roundish erythematous annular plaques with a violaceous (bullous) aspect on one of the lesions (right groin)

Based on the slightly more than 2 week history the lesions could fit with a fixed drug reaction: was any new drug administered recently ?

HOWEVER the lesions are multiple and although multiple fixed drug eruptions can occur other conditions need to be excluded:
-the differential would include systemic conditions (collagenosis...) and a FBC and ANA screen might be useful.
-a skin biopsy could ascertain skin changes which might be useful if systemic changes are not found (morphea...)
CH

More comments ?
CFH
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Re: Oval Annular Erythematous Plaques with Violaceous Centre

Postby JHS » Sat Apr 25, 2015 6:33 pm

This is Fixed drug eruption as very first diagnosis
I wonder if the center is purpuric (not clear on the picture) , if so coumarin hs may be a diff diag but unlikely in this context.
Check drugs intake and urgently stop them all including "natural medicines"
JHS
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Re: Oval Annular Erythematous Plaques with Violaceous Centre

Postby Bilal Dar » Sat Apr 25, 2015 9:51 pm

Thanks for quick response and reaching the diagnosis of FDE , but fever which is high grade and persistent confuses ; the boy told me that he was not taking any medicine when he discovered these plaques. May be some food additive had been the cause ?
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