Intended for healthcare professionals

Endgames Spot Diagnosis

An unusual rash on the feet

BMJ 2018; 361 doi: (Published 24 May 2018) Cite this as: BMJ 2018;361:k1406
  1. Claire Wilson, FY21,
  2. Noha Elshimy, dermatology SpR2
  1. 1Leeds Hospitals Teaching Trust, Leeds, UK
  2. 2Mid Yorks Hospitals Trust, Wakefield, UK
  1. Correspondence to C Wilson claire.wilson29{at}

A 51 year old white homosexual man was admitted with cellulitis of the left leg. His medical history included psoriasis, for which he had received six years of methotrexate. The methotrexate was stopped 11 years before this presentation and he had not experienced any active psoriasis since then. Examination revealed multiple painless, indurated violaceous plaques and verrucous growths on the dorsal and plantar aspects of both feet (fig 1). Further questioning revealed that these lesions had been present for more than 10 months. There was no evidence of psoriasis on examination. What investigation would you request?

Fig 1

Violaceous plaques and verrucous growths on both feet


These lesions are characteristic of cutaneous Kaposi’s sarcoma. Methotrexate immunosuppression alone is unlikely to cause the condition, so an HIV …

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