Fatigue, macroglossia, xanthomatous papules and bullae
C-9 New Medical Enclave, Banaras Hindu University, Varanasi - 221 005
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Singh S, Kumar S, Chaudhary R. Fatigue, macroglossia, xanthomatous papules and bullae. Indian J Dermatol Venereol Leprol 2010;76:216
A 45-year-old man had fatigue, nail dystrophy (thinning, striations) (13 months); diffuse scalp alopecia, macroglossia, dysphagia (4 months); xanthomatous lesions, hoarseness, generalized pruritus (3 months); and bullae (6 weeks). Except pallor and expressionless face, general and systemic examination was normal. Itchy, xanthomatous papules were present on the back [Figure - 1], and tense vesicles and bullae, some with hemorrhagic fluid, were on the limbs and abdomen.
Hemoglobin was 7.8 g/dl, and ESR was 31 mm. Blood counts, routine urinalysis, and serum biochemistry including calcium level, X-rays and ultrasonography (abdomen) were normal. The 24-h urinary protein was 360 mg/dl. Skin biopsy [Figure - 2] and bone-marrow examination [Figure - 3] were performed.
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