History of Present Illness

A man in his mid-60s with a history of gout presents to the emergency department with a 2- to 3-week history of a gradually worsening rash on both lower legs, especially on the shins. The patient denies fever or pain but reports the rash sometimes feels slightly itchy. He denies eating any new foods or using any new skin care products or medications.

Vital Signs and Physical Examination

The patient’s vital signs and physical examination in the emergency department are normal including temperature. The only presenting symptom is a violaceous rash (Figure).

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