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Am Fam Physician. 2022;105(2):189-190

Author disclosure: No relevant financial relationships.

A 20-year-old man presented with a six-month history of inflamed bumps and what appeared to be focal bruising on his legs, thighs, and arms that left persistent hyperpigmentation after resolution. The rash had been exacerbated by heat exposure and appeared worse at night. He had joint pain and paresthesia but no photosensitivity, malar rash, alopecia, or mouth ulcers. When he consulted a rheumatologist, he had an elevated antinuclear antibody titer of 1:160. The patient was taking aspirin and acetaminophen and using a topical diclofenac sodium solution. He had no relevant family, medical, or social history. He did not abuse alcohol.

Physical examination revealed faint, dark purple, hyperpigmented patches in a reticular pattern, forming several complete rings on his dorsal thighs and a few on his lower legs and arms (Figure 1).

Question

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

  • A. Cutaneous polyarteritis nodosa.

  • B. Drug hypersensitivity reaction.

  • C. Takayasu arteritis.

  • D. Urticarial vasculitis.

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The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at https://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. Email submissions to afpphoto@aafp.org.

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at https://www.aafp.org/afp/photoquiz

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