case_images: PMC7294561_01
case_images: (A) Bruises on the left upper extremity, which developed after the second intra-articular injection. (B) Bruise on the left lower extremity which developed into a non-healing ulcer. (C) Cushingoid facies and facial plethora. The picture on the left was taken a week prior to the first intra-articular injection, and the second picture was taken nearly 2 months after the second injection. (D and E) Wide, violaceous striae on the chest (D) and abdomen (E).
case_images: IMCRJ-13-229-g0001.jpg
case_images: PMC7294561_01_IMCRJ-13-229-g0001.jpg
case_images: F0001
case_images: In the weeks after his second knee injection he noticed easy bruising (Figure 1A), a bruise on his left leg became infected and progressed to a slow-healing ulcer (Figure 1B), and over the next 2 months he experienced significant weight gain, cushingoid facies and facial plethora (Figure 1C). Angiography (CTA) of the chest and a deep vein thrombosis (DVT) via doppler ultrasound of the lower extremities. At this time violaceous striae were noted on his abdomen (Figure 1D and 1E).
case_images: Follow-up images were collected at the patients most recent outpatient appointment, 7 months after the first intra-articular injection, showing resolution of symptoms. Of note resolution of (A) Cushingoid facies, (B) extremity bruising, wide violaceous striae of the (C) chest and (D) abdomen.
case_images: IMCRJ-13-229-g0002.jpg
case_images: PMC7294561_01_IMCRJ-13-229-g0002.jpg
case_images: F0002
case_images: ACTH 25.4, cortisol 6.1, aldosterone 2.9, renin 0.776, sodium 141, and potassium 4.1. Additionally, his symptoms - namely his easy bruising, wide violaceous striae on the chest and abdomen, Cushingoid facies and facial plethora have improved, as seen in Figure 2, and he reports feeling much better.