A featured unknown case with step-by-step walkthrough. Test yourself, then learn.
A 54-year-old woman with a history of renal transplantation came in with a diffuse, pink papular eruption on her arms and legs. She was on tacrolimus, recently shifted to an asymmetric dosing schedule, and had just recovered from a bout of loose stools. On exam, the papules had a fine, spiny quality — almost like…
A 48-year-old woman had blue-gray patches on her forehead, cheeks, and the backs of her hands for three years. Slowly spreading. No pain, no itch, no ulceration. Just a strange, persistent discoloration that didn’t fit anywhere obvious. Her clinicians ran through the usual suspects: exogenous ochronosis, hemochromatosis, Addison disease, drug-induced pigmentation from something like minocycline…