A Scrotal Rash Lasting Months in a Man With Genital Edema

Winston W. Tan, MD; Matthew S. Soberano, DO; A. Toledo, DO; Matthew Clarence Tan


June 23, 2022

Physical Examination and Workup

The patient appears alert and oriented with no focal deficits and mild, acute distress. He is cooperative, with appropriate mood and affect. His blood pressure is 150/78 mm Hg. His heart rate is 103 beats/min. His respiratory rate is 22 breaths/min. His temperature is 98°F (36.7°C). His weight is 187.4 lbs (85 kg).

His pupils are equal, round, and reactive to light with normal conjunctiva. He has a prominent jugular venous pulse. His oral mucosa is moist, with no pharyngeal erythema. His neck is supple without carotid bruit. His breath is nonlabored, and the breath sounds are equal. He has symmetrical chest wall expansion, with faint crackles in the lower lobe. His cardiovascular findings reveal normal peripheral perfusion with no obvious carotid bruit heard bilaterally. He has a 4/6 systolic murmur in the midchest.

His abdomen is soft, nontender, and nondistended, with normal bowel sounds. He reports no diarrhea or constipation. He has grade 2 edema and a slightly unsteady gait when standing and uses a cane. The rash on the scrotum is maculopapular and on the right side. It has no exudate, is nontender, and does not have ulceration.

His PSA level is 155 ng/dL. His complete blood count is normal. His alkaline phosphatase level is 238 U/L (reference range, 44-147 IU/L). Chest radiography reveals bilateral lung infiltrate consistent with congestive heart failure. He has no chest pain or shortness of breath. A bone scan reveals evidence of rib and spine metastasis with no bone pain.


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