Christina Harview is a Dermatology Resident at the University of Iowa in Iowa City. Mary White is a Home-Based Primary Care Attending Physician and Associate Professor of Medicine, and Sarah Tubbesing is the Medical Director of Home-Based Primary Care and Assistant Professor of Medicine; both at the VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at the University of California, Los Angeles. Correspondence: Mary White ([email protected])
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
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A 73-year-old male veteran with a history of ischemic stroke with left-sided deficits and edema, falls, poorly controlled hypertension, active tobacco use, obesity, and prediabetes was assessed on a routine visit by our home-based primary care team and found to have a new, unilateral, asymptomatic rash. He reported feeling no pain in the affected area or any significant increase in the baseline left lower extremity edema and weakness resulting from his stroke 2 years prior.
On the left lateral leg from mid-thigh to mid-calf, there was a nontender, flat, reticulated rash with pigmentary alteration ranging from light brown to dark brown (Figure).
On further questioning, the patient reported regular use of a space heater because his gas furnace had been destroyed in an earthquake more than 20 years before. He would place this heater close to his left leg when using the computer or while sleeping in his wheelchair.