Derm Case Challenge: Rash on Chest, Buttocks and Toenail Changes in a Middle-Aged Man

Lindsay Irwin, BS; Preeya T. Shah, MD; Richard Harold Flowers IV, MD

Disclosures

September 06, 2022

Physical Examination and Workup

The patient's vital signs are unremarkable. Examination of the skin reveals the rash shown in Figure 1. He has similar involvement over his upper and mid-back (Figure 2 and Figure 3).

Figure 1.

Figure 2.

Figure 3.

The patient has no palpable lymphadenopathy on examination of bilateral cervical, supraclavicular, axillary, and inguinal lymph nodes. Auscultation of the heart reveals normal S1 and S2; regular rate and rhythm; and no murmurs, rubs, or gallops. The patient's lungs are clear to auscultation bilaterally, his abdomen is soft and nontender to palpation, and no proximal muscle weakness is noted.

Results of a complete blood cell count, comprehensive metabolic panel, and measurement of antinuclear antibodies (ANA) and anti-Ro/SSA and anti-La/SSB antibodies are within normal limits.

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