Medical Images
Mixed Essential Cryoglobulinemia
A 53-year-old man with a long-standing history of hepatitis C infection complicated by recurrent ascites and hepatorenal syndrome presented with a gradually worsening rash that started after sun exposure. The rash was initially raised and erythematous, gradually progressing to palpable purpura on his hands (Figure, A) and painful skin necrosis on his shins (Figure, B). Laboratory studies revealed an IgG level of 2304 mg/dL, IgA level of 452 mg/dL, and IgM level of 185 mg/dL with low C4 complement (.12 L).Brothers with Congenital Erythropoietic Porphyria
Two brothers, one 16 and the other 18 years of age, presented to our outpatient service for multiple recurrent blisters and erosions on sun-exposed areas. On physical examination they showed multiple hypopigmented scars of variable sizes on the face (Figure 1), upper chest, and dorsal aspects of the upper extremities. In addition to destruction of the ear lobes (Figure 2) and the cartilage of the nose, erythrodontia, resorption of the distal phalanges in the hands (Figure 3), hypertrichosis of the face and extremities (Figure 1), and hepatosplenomegaly were present.
