A 54-Year-Old Female with Recently Diagnosed Diabetes Mellitus Presents to the Office

question 525

Multiple Choice

A 54-year-old female with recently diagnosed diabetes mellitus presents to the office with a skin rash.  She states that the rash started three weeks ago on her forearm as a small, elevated red area.  It gradually  involved the surrounding skin, and became an erythematous, itchy, painful rash that did not respond to topical 1% hydrocortisone.  Approximately one week ago, the rash started clearing up from the center.  The patient has not been feeling well for the past 1-2 months.  She also complains of lethargy, weight loss, diarrhea, abdominal cramps, and occasional facial flushing.  On physical examination, a 4 X 5 cm, erythematous, scaly rash, which appears to be clearing from center, is noted.  The borders appear slightly elevated and crusty.  Angular cheilosis is also noted.  What is the most likely diagnosis of this patient?

• A)Pellagra
• B)Systemic lupus erythematosus
• C)Fungal infection
• D)Glucagonoma
• E)Mastocytosis