Waxing and waning eczematous dermatitis and glossitis

Abstract

Fig 2 View Large Image Figure Viewer Download Hi-res image Fig 3 View Large Image Figure Viewer Download Hi-res image A 61-year-old woman presented with a 3-year history of a recurrent, painful rash and tongue pain. She denied jaundice, fatigue, abdominal pain, or a change in bowel habits. The physical examination revealed atrophic glossitis and thin, scaly, erythematous, tender plaques and scattered erosions on her face, trunk, perineum, buttocks, gluteal cleft, and extremities (Fig 1, Fig 2, Fig 3). Her abdomen was soft, nontender, and without palpable masses. A skin biopsy obtained by a different institution revealed “eczema.” However, she experienced minimal relief with topical or systemic corticosteroids. Two years after onset of the rash, she developed nausea, vomiting, and an unintended weight loss of 10 kg, which prompted additional work-up and treatment. 1.What is the most likely diagnosis? A.Drug eruption B.Seborrheic dermatitis C.Necrolytic migratory erythema D.Tinea corporis E.Necrolytic acral erythema 2.Which of the following is the most specific test for diagnosing the underlying cause of the patient's rash? A.Serum glucagon level B.Serum zinc level C.Potassium hydroxide preparation D.Hepatitis C serologies E.Absolute eosinophil count 3.What would be an appropriate first-line treatment for the underlying cause of the patient's eruption? A.Topical steroids B.Topical antifungal medications C.Nutritional supplementation D.Surgical resection E.Antiviral medications