A 91-year-old woman with Alzheimer's disease presented to our outpatient clinic with
eruption on the face that she had noticed 2 days previously after waking up. She was
not taking any oral antiplatelet or anticoagulant drugs. On examination, fine petechiae
were noted on the bilateral periorbital areas, cheeks, and forehead (Fig. 1.A), and there was a hematoma on the left side of the tongue, suggesting tongue biting
(Fig. 1.B, white arrow). She had no enlarged tongue. Platelet count, coagulation profile,
total protein level, and electrolytes were normal, and neurological exam was unremarkable.
Electrocardiogram showed no abnormalities, and head CT showed brain atrophy compatible
with Alzheimer's disease without space occupying lesions. Based on these findings,
the rash was diagnosed as thoraco-cervicofacial purpura caused by epileptic seizure
due to Alzheimer's disease. It was thought that an epileptic seizure must have occurred
while the patient was asleep. The facial rashes disappeared without treatment after
3 weeks (Fig. 1.C).
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References
- Epilepsy under my skin?.BMJ Case Rep. 2018; 2018bcr2017224136
- Epilepsy in older people.Lancet. 2020; 395: 735-748
- Seizures and epilepsy in Alzheimer's disease.CNS Neurosci Ther. 2012; 18: 285-294
Article info
Publication history
Published online: August 19, 2022
Accepted:
August 15,
2022
Received:
August 11,
2021
Identification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
