case_images: PMC9234257_01
case_images: (A) Peri-oral lesions. Palatal and buccal mucosal ulcers and maculopapular lesions, lip crusts. (B-D) Scales on nipple, ulceration of genital, and nail lesions on fingers and toes.
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case_images: PMC9234257_01_fmed-09-917050-g0001.jpg
case_images: F1
case_images: He had ulcerated and bullous lesions on the palate, cheek mucosa, and blood crust on his lip (Figure 1A). The second physical examination revealed some neglected lesions, including nipple scales, genital ulcers, and nail lesions on fingers and toes (Figures 1B-D).
case_images: (A) Electrocardiogram for the first (emergency department). Sinus tachycardia, mild depression of the ST segment in V3~V5, T wave inversion in lead V1, and bidirectional in lead V4. (B) Electrocardiogram for the second time (the ward of the department of cardiovascular disease).
case_images: fmed-09-917050-g0002.jpg
case_images: PMC9234257_01_fmed-09-917050-g0002.jpg
case_images: F2
case_images: An electrocardiogram showed sinus tachycardia, mild depression of ST-segment in V3~V5, T wave inversion in lead V1, and bidirectional in lead V4 (Figure 2A). Electrocardiogram for the second time remained no distinctly dynamic changes (Figure 2B).
case_images: Chest radiography. The cardio-thoracic proportion of 0.47, elevating dexter diaphragm.
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case_images: PMC9234257_01_fmed-09-917050-g0003.jpg
case_images: F3
case_images: Chest radiography showed a cardio-thoracic proportion of 0.47, an elevation of the dexter diaphragm, and no acute pulmonary process (Figure 3).
case_images: (A,B) Computed tomography (CT) scan of the thorax and abdomen. A well-defined tumor between the spleen and stomach, measuring 117 x 108 x 91 mm, accompanied by an abundant blood supply and enlarged retroperitoneal lymph nodes. (C,D) The histopathological evaluation of the skin lesions. Suprabasilaracantholysis, keratinocyte necrosis, basal layer damage, and inflammatory cell infiltration in the superficial dermis, including lymphocytes and plasma cells.
case_images: fmed-09-917050-g0004.jpg
case_images: PMC9234257_01_fmed-09-917050-g0004.jpg
case_images: F4
case_images: Subsequent computed tomography (CT) scan of the thorax and abdomen demonstrated a well-defined tumor between the spleen and stomach, measuring 117 x 108 x 91 mm, accompanied by the abundant blood supply and enlarged retroperitoneal lymph nodes (Figures 4A,B). The histopathological evaluation of the skin lesions revealed suprabasal acantholysis, keratinocyte necrosis, basal layer damage, and inflammatory cell infiltration in the superficial dermis, including lymphocytes and plasma cells, which were compatible with PNP (Figures 4C,D).