Photo Quiz

Lateral Neck Lesions with Vision Changes

 

Am Fam Physician. 2016 Dec 1;94(11):921-922.

A 39-year-old man presented with bilateral blurry vision that began suddenly three days prior. He did not have any recent eye injuries, irritation, pain, or drainage. He had no other symptoms.

Physical examination revealed normal conjunctiva and sclera without erythema, discharge, or foreign body; the pupils were normal. Funduscopy showed abnormal streaks in a spoke-like pattern extending from the optic disc. Confluent, yellow papules and plaques were observed on the lateral aspects of the neck (Figure 1). The skin changes had developed during middle school, and the patient attributed it to a birthmark. The lesions were not painful or pruritic.


Figure 1.

Question

Based on the patient's history and physical examination findings, which one of the following is the most likely diagnosis?

A. Cutis laxa.

B. Dermatofibrosis lenticularis disseminata.

C. Hyperlipidemia xanthoma.

D. Lichen simplex chronicus.

E. Pseudoxanthoma elasticum.

Author disclosure: No relevant financial affiliations.

Address correspondence to Marisol Clark, MD, at mclark2@wilmingtonhealth.com. Reprints are not available from the authors.

REFERENCES

show all references

1. Dyer JA. Lipoid proteinosis and heritable disorders of connective tissue. In: Goldsmith LA, Fitzpatrick TB, eds. Fitzpatrick’s Dermatology in General Medicine. 8th ed. New York, NY: McGraw Hill; 2012....

2. Fenske NA. Pseudoxanthoma elasticum. Updated October 20, 2015. http://emedicine.medscape.com/article/1074713-overview. Accessed March 17, 2016.

3. Usatine RP, Smith MA, Mayeaux EJ. Hyperlipidemia and xanthomas. In: Usatine R, ed. The Color Atlas of Family Medicine. 2nd ed. New York, NY: McGraw Hill; 2013.

4. Wolff K, Johnson RA, Saavedra AP. Lichen simplex chronicus (LSC). In: Wolff K, Johnson RA, Saavedra AP, Fitzpatrick TB, eds. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 7th ed. New York, NY: McGraw Hill; 2013.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

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