Papular-purpuric gloves and socks syndrome

Abstract

In January, 2010, a 42-year-old woman was admitted to our emergency department with fever (39°C), severe malaise, and severe dark red itchy swelling of both hands and feet, which was strictly demarcated at the ankles and wrists (figure A). On physical examination she was obese with body-mass index 64 kg/m2 (normal 21–26); she denied taking any medication. Laboratory tests showed high concentrations of C-reactive protein (50 mg/L), and slightly high concentrations of aspartate (48 U/L) and alanine (52 U/L) aminotransferases. HbA1C was 7·3%, and full blood count and renal function tests were normal. We made the provisional diagnosis of angio-oedema, and our patient was given dimetindenmaleat 4 mg intravenously. (A) Photographs of our patient's right hand and foot showing oedema and erythema with papules and petechiae; and (B) histopathology showing intra epidermal cleft formation and oedema with vasculitis under a necrotic epidermis.