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Case Records of the Massachusetts General HospitalFree Preview

Case 12-2021: A 78-Year-Old Man with a Rash on the Scalp and Face

List of authors.
  • Michael K. Yoon, M.D.,
  • Hillary R. Kelly, M.D.,
  • Suzanne K. Freitag, M.D.,
  • Alexander G. Marneros, M.D., Ph.D.,
  • Miriam B. Barshak, M.D.,
  • and Diane G. Brackett, M.D.

A 78-year-old man was admitted with a forehead and scalp rash and eyelid edema on the left side. The rash spread to the right side, with lesions appearing as punched-out erosions with hemorrhagic crust. The patient was unable to open his eyes; he began to have visual hallucinations and seemed confused. A diagnostic test was performed.

Funding and Disclosures

This case was presented at Massachusetts Eye and Ear Ophthalmology Grand Rounds.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Dr. Kelly reports receiving research funding and fees for serving as a principal investigator, paid to her institution, from Bayer Pharmaceuticals; Dr. Freitag, receiving advisory board fees and consulting fees from Horizon Therapeutics and consulting fees from W.L. Gore; and Dr. Barshak, owning stock in Pfizer, Boston Scientific, St. Jude Medical, and Viatris. No other potential conflict of interest relevant to this article was reported.

We thank Dr. Ruth Foreman for review of the pathological discussion.

Author Affiliations

From the Departments of Ophthalmology (M.K.Y., S.K.F.) and Radiology (H.R.K.), Massachusetts Eye and Ear, the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Massachusetts General Hospital, and the Departments of Radiology (H.R.K.), Dermatology (A.G.M.), Medicine (M.B.B.), and Pathology (D.G.B.), Harvard Medical School all in Boston.

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