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Morning facial rash: A clue to night epileptic seizure

Published:August 19, 2022DOI:https://doi.org/10.1016/j.amjms.2022.08.007
      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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