A MALE PATIENT WITH NET-LIKE HYPERPIGMENTATION ON THE LOWER LIMBS

A 35-year-old male presented with complaints of jaundice and persistent epigastric pain for two weeks. He also complained of net-like hyperpigmentation on both the legs that developed over last three months. He used to drink alcohol frequently for last 5-6 years. He was normotensive and non-diabetic. He had no history of fever, arthralgia or oral ulcers. Examination revealed mild epigastric tenderness with tender hepatomegaly. On the medial aspects of both legs he had reddish-brown pigmentation in reticulated pattern (Figure 1). The lesion was non-tender and there was no ulceration or scaling on the skin. Laboratory evaluation showed mild leucocytosis, Serum alanine aminotransferase (ALT) 180 U/L, aspartate aminotransferase (AST) 256 U/L, Alkaline Phosphatase 110 IU/L, total bilirubin 4.5 mg/dL and normal serum lipase. Blood borne virus screening (namely, HBsAg and antibodies to HCV and HIV) were negative. Lupus anticoagulant and anti-cardiolipin antibody were also negative. Ultrasound abdomen revealed hepatomegaly with fatty changes in liver, normal portal and hepatic veins with normal pattern of blood flow. He was diagnosed to have alcoholic hepatitis. Upon further questioning, it was revealed that he had a developed a habit to sit next to an earthen oven with a fire in it for several hours during winter months.