ABSTRACT
With a wide variety of associated diseases, proper diagnosis and
treatment of annular rashes can prove clinically challenging. It is
essential to remain vigilant of atypical presentations of disease and to
complete a comprehensive history, physical, and workup to ensure optimal
patient care.
Keywords: annular rash, IgA-vasculitis, cat scratch disease,
DRESS syndrome, Henoch Schönlein purpura
INTRODUCTION
Annular lesions—plaques, macules, nodules, or pustules with a
ring-like morphology—have been documented in over 30 distinct diseases
and disorders. With a wide differential inclusive of both isolated
cutaneous disease and systemic disease, proper diagnosis and treatment
of an annular rash can prove challenging for clinicians. Extreme
variability in symptomology further complicates the diagnostic process
[1]. In this report we describe the unique case of a 53-year-old
gentleman who presented with a
progressing annular rash in the setting of multiple risk factors for
systemic diseases. While his initial presentation was
concerning for cat scratch
disease (Bartonella henselae infection) or drug reaction with
eosinophilia and systemic symptoms (DRESS) syndrome, thorough evaluation
suggested a nonclassical presentation of IgA vasculitis (IgAV). This
report will discuss the difficulty in diagnosing and treating annular
eruptions and review current literature regarding the epidemiology and
presentation of associated disorders.
CASE PRESENTATION