Photo Quiz: a Woman with a Pruritic Rash and Unilateral Vision Loss.

Abstract

A 39-year-old female with a history of hypertension and allergic rhinitis presented with a 4-week history of a diffuse pruritic skin eruption and a 2-week history of progressive vision loss in the right eye. Physical exam was notable for a diffuse eruption of pink, scaly coalescent plaques with a thin rim of white scale on the face, trunk, and extremities (Fig. 1, left). There was no involvement of the mucous membranes. One to 2 weeks following the skin eruption, she experienced blurry vision progressing to complete vision loss without associated trauma. On fundoscopic exam, blood was noted in the anterior chamber of her right eye (hyphema). There was concern for uveitis on exam without other focal neurologic deficits. The patient denied recent travel or prior adverse effects of medications. She smoked cigarettes and marijuana occasionally without recent intravenous drug use.