^*Aakash Akhare,

^*Post-graduate Resident, Lady Hardinge Medical College, New Delhi

 

A 63 year old female, resident of Nabi Karim, New Delhi, educated up to class 7 presented to the Medicine OPD with chief complaints of:

• Uncontrolled hyper-glycemia since last 4 years despite diabetic diet and adequate treatment
• Worsening Ulcerating rash primarily on the shin, groin and face since last 4 years
• Severe weight loss
• Oral ulcers since last 4 years
• Abdominal pain and intractable nausea for 1 year

Patient was taking Antidepressants from psychiatry OPD since last 2 years.

General physical examination revealed ulcerating rash primarily on the shin, groin and face. Lips appear reddened, swollen and cracked (cheilitis), tongue appeared reddened, swollen with presence of ulcers (glossitis). Rest general examination was unremarkable.

Systemic examination revealed mild epigastric tenderness only.