A man with fever and cogwheel-like dermal lesions

Excerpt

A 50-year-old man presented to our emergency department with progressive skin lesions and fever. He reported that the lesions had first appeared 40 days previously following cough and fever (the highest body temperature was 40 ℃). The lesion on the right thigh first presented as a single small red papule with a blister (Fig. 1A) and rapidly progressed to a larger, dark red edematous plaque (Fig. 1B). Then, the patient was admitted to the local hospital with a diagnosis of cellulitis, although repeated bacterial culture of the secretion and metagenomic next generation sequencing (NGS) analysis were all negative. After receiving debridement and anti-infection therapy at the local hospital, the appearance of his dermal lesions did not show a marked improvement. Then, the dermal lesions progressed again with recurring fever after 1 month (the highest body temperature was 39.9 ℃). The lesions appeared cogwheel-like, with raised borders and tenderness. After admission to our hospital, the lesions continued to rapidly expand outwards with blisters and ulceration (Fig. 1C). In addition, the patient had a history of thrombocytopenia for more than 6 years and received long-term oral Eltrombopag 25 mg twice a day (a second-generation thrombopoietin receptor agonist).

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