images in clinical medicine
The new england journal of medicine
n engl j med 367;2 nejm.org july 12, 2012
Physical examination revealed diffuse, large, edematous plaques that were yellow with an erythematous edge. Blood test-
ing revealed that the patient had hyperbilirubinemia (direct bilirubin level, 7.5 mg per deciliter [128 μmol per liter]; total
bilirubin level, 8.4 mg per deciliter [144 μmol per liter]) and elevated aminotransferase levels. A skin-biopsy specimen
revealed edema, and Hall’s staining of the specimen for bilirubin revealed focal deposits of olive-green crystals. Yellow
urticaria was diagnosed. In a patient with jaundice, the edema fluid associated with urticaria may appear yellow owing
to the high bilirubin level. Although the urticarial lesions were treated effectively with antihistamines, the patient died
during the hospitalization because of progression of the underlying breast cancer.
43-year-old woman presented to the hospital after 5 days of itchy, diffusely distributed,
evanescent lesions. Ductal carcinoma of the breast had been diagnosed 11 years earlier; despite breast-conserving
surgery, radiation, and several rounds of chemotherapy, metastatic disease to the liver and bone had developed.
Copyright © 2012 Massachusetts Medical Society.
Basilio Narváez-Moreno, M.D.
José Juan Pereyra-Rodríguez, Ph.D.
University Hospital Virgen del Rocio
The New England Journal of Medicine
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Copyright © 2012 Massachusetts Medical Society. All rights reserved.