Race for the Case

Race for the Case is a clinical quiz feature published quarterly in DermWorld Directions in Residency — and right here!

Answer the questions below to enter. Looking for the Spring 2025 answers? Review them now. To submit cases and questions, email Emily Margosian at emargosian@aad.org.

Diagnose this new case by Frank Z. Jing, MD, and Nessa Aghazadeh Mohandesi, MD, FAAD

A 75-year-old man with a history of gastroesophageal reflux and deep vein thrombosis presented with a six-month history of unintentional 20-pound weight loss and decreased appetite. He also reported a persistent full-body eruption for the past month, which will periodically improve without treatment but then re-intensify. The individual lesions were mildly tender to palpation. Additionally, he noted increased redness involving the ears, affecting one or both sides intermittently. He was unsure if this was related to sun exposure. He denied fevers, chills, abdominal pain, or joint pains. A recent bone marrow biopsy revealed variably cellular bone marrow with erythroid hypoplasia and no increase in blasts. His hemoglobin was 7.1 g/dL, mean corpuscular volume (MCV) 97.5 fL, platelet count 225 x 10(9)/L, leukocytes 3.0 x 10(9)/L, and erythrocyte sedimentation rate (ESR) 132 mm/h.

1. Based on the symptoms, clinical photos, and laboratory evaluation, what syndrome should you be suspicious of?

2. How could you confirm your suspicion in question one and what are you looking for specifically?

3. What abnormalities would you expect to see on a complete blood count?

4. What finding(s) would you expect to see on histopathology?

5. What is the first-line treatment for this disease?

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