Purpuric macules and plaques in a patient with myasthenia gravis

A 79-year-old Caucasian man was referred to us for evaluation of asymptomatic, widespread, purpuric macules and plaques that had fi rst appeared on his legs three months earlier. One year before, he had been diagnosed with stage IIIB myasthenia gravis (according to Osserman’s classifi cation). He had initially been treated with prednisone and pyridostigmine, followed by a slow corticosteroid taper and the introduction of azathioprine. The lesions subsequently worsened, especially after corticosteroid reduction and upping of the azathioprine dose. Other medications the patient had been taking included lysine acetylsalicylate for subcortical vascular encephalopathy and pantoprazole for gastroesophageal refl ux. Viral markers such as HBV, HCV, and HIV were negative. The diagnostic workup including Purpuric macules and plaques in a patient with myasthenia gravis Case for Diagnosis