case_images: PMC11787870_01
case_images: Patient's first visit (week 13) shows several well-demarcated, somewhat annular, erythematous-to-violaceous papules and plaques with overlying scale and crust on the (A) right forearm, hand, and (B) chest. The crust is primarily localized to the peripheral borders, with small areas of surrounding erythema.
case_images: cureus-0017-00000076869-i01.jpg
case_images: PMC11787870_01_cureus-0017-00000076869-i01.jpg
case_images: FIG1
case_images: On physical exam, several well-demarcated plaques with overlying scale and crust were seen on the right hand, chest, lower neck, back, and lower legs (Figure 1).
case_images: Patient's follow-up visit (week 37) shows annular, violaceous patches and plaques with minimal secondary change located diffusely on the (A) back and (B) chest. Lesions are predominantly localized to the lower back where they appear as a deeper violaceous color. Again, there is some crust seen with an underlying base of erythema. The symmetrical distribution is helpful in narrowing down the differential diagnosis to an autoimmune or inflammatory dermatosis.
case_images: cureus-0017-00000076869-i02.jpg
case_images: PMC11787870_01_cureus-0017-00000076869-i02.jpg
case_images: FIG2
case_images: Physical exam showed annular violaceous patches and plaques with minimal secondary change located diffusely on the trunk and extremities as well as erythematous plaques on the face (Figure 2 and Figure 3).
case_images: Follow-up after a 15-day course of prednisone shows symmetrical, targetoid papules and plaques with violaceous center and pink erythema peripherally on the bilateral arms with the absence of secondary changes or crusting. These findings are considered erythema multiforme-like and raised suspicion for Rowell syndrome; however, this diagnosis was ruled out due to a lack of supportive laboratory findings.
case_images: cureus-0017-00000076869-i03.jpg
case_images: PMC11787870_01_cureus-0017-00000076869-i03.jpg
case_images: FIG3
case_images: Physical exam showed annular violaceous patches and plaques with minimal secondary change located diffusely on the trunk and extremities as well as erythematous plaques on the face (Figure 2 and Figure 3).
case_images: Timeline of clinical presentation and biopsies starting from initial symptom onset to final diagnosis.
case_images: cureus-0017-00000076869-i04.jpg
case_images: PMC11787870_01_cureus-0017-00000076869-i04.jpg
case_images: FIG4
case_images: A timeline of clinical presentation is outlined in Figure 4.