Seven months after Hurricane Katrina, a 52-year-old African American woman who was evacuated from New Orleans came to our office with a hypopigmented rash on both her upper thighs and arms. Immediately following the 2005 hurricane, she was forced to wade through the polluted waters of New Orleans for many hours before being rescued by boat. Four days passed before she had access to a shower. It was after this shower that she first noticed a single erythematous spot the size of a silver dollar on her left thigh, that several weeks later faded to hypopigmented macules and plaques. Over time, the rash spread to both thighs and arms (FIGURE 1 AND 2. She did not have any itching, pain, bleeding, fever, chills, weight changes, or gastrointestinal symptoms after the rash appeared.
The patient reported that she was married and had worked as a chef for 20 years. She smoked cigarettes, drank alcohol occasionally, and was obese. She had synovitis of her left ankle, which led to surgery. She had no known drug allergies and was taking ibuprofen. Her mother, age 79, had glucose intolerance; her father, age 82, had a renal cell carcinoma removed.
Due to a confluence of situational, economic, and medical problems, she did not seek care for this rash until April 2006. At that time, a punch biopsy revealed the findings in FIGURE 3. Physical exam revealed her skin to have symmetrically distributed hypopigmented macules and plaques to all 4 extremities. She had no lymphadenopathy.
FIGURE 1
Rash on patients’ legs
FIGURE 2
Rash on right arm
FIGURE 3
Hematoxylin/eosin stain
What is the diagnosis?
Were Katrina’s flood waters to blame?