SHM Converge Scientific Abstract ePoster Gallery-Revenge of the Space Heater

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A 37-year-old woman with no significant past medical history presented with several weeks of worsening crampy leg pain, fatigue, lightheadedness, dyspnea on exertion, and a discoloration rash on both legs. She denied bleeding symptoms and had normal menses. In the emergency department, she was tachycardic and found to have severe microcytic anemia with hemoglobin 6.8 g/dL and iron studies consistent with iron deficiency (low iron, ferritin 3 ng/mL, low transferrin saturation). She was transfused one unit of packed red blood cells with appropriate improvement.<br /><br />Examination of the lower extremities showed fixed, variegated brown retiform patches and thin plaques, raising concern for livedo reticularis. Dermatology obtained additional history and learned that, because her legs felt cold and crampy, she had been placing a space heater directly between her thighs for several hours daily over the prior few months. Based on the chronic, direct heat exposure and the characteristic localized reticulated hyperpigmented rash, the diagnosis was erythema ab igne.<br /><br />Erythema ab igne is a rare skin condition caused by repeated exposure to direct heat or infrared radiation, producing a reticulated, hyperpigmented rash that can resemble livedo reticularis. Historically it affected people with occupational heat exposure, but modern cases occur with space heaters, heating pads, and heated car seats. The main treatment is stopping the heat exposure.<br /><br />This case highlights the importance of a careful history when evaluating a reticular rash. The differential includes drug-induced reticulate hyperpigmentation, confluent and reticulated papillomatosis, prurigo pigmentosa, and livedo reticularis. Because livedo reticularis can signal systemic vasculitis, it is the key diagnosis to exclude.

Asset Subtitle

Viniya Patidar

Meta Tag

Author List Bonnie Cruser MD, Viniya Patidar

Category Clinical Vignettes

Concept Erythema Ab Igne

Concept Heat Exposure

Concept Livedo reticularis

Concept Reticulated Rash

Concept Localized Heat Source

Distinguished Non-Finalist

Presenter Organization Emory University School of Medicine

Presenting Author Viniya Patidar

Track Adult

Keywords

erythema ab igne

reticulated hyperpigmentation

space heater exposure

livedo reticularis

iron deficiency anemia

microcytic anemia

retiform rash

heat-induced skin injury

dermatology diagnosis

lower extremity rash

Erythema Ab Igne

Heat Exposure

Livedo reticularis

Reticulated Rash

Localized Heat Source