Malar rash with pulmonary hypertension and chronic obstructive pulmonary disease

Description

Malar rash is a fixed erythema involving the facial cheeks and nasal bridge with sparing of the nasolabial folds. It has a classic butterfly appearance (figure 1). Its causes include local and systemic diseases, including rosacea, erysipelas and systemic lupus erythematosus (SLE).1 Rarely it occurs due to mitral stenosis with reduced cardiac output and pulmonary hypertension.2 Its association with severe pulmonary hypertension from chronic obstructive pulmonary disease (COPD) is not commonly described.

We recently admitted a 76-year-old woman to our intensive care unit with dyspnoea and cough on a background of COPD. On examination she had a malar rash (figure 1) in association with a respiratory rate of 24 breaths/min, raised jugular venous pressure, peripheral oedema and signs of peripheral venous congestion including leg ulcers and hyperpigmentation of her extremities. Admitting arterial blood gas showed pO₂ of 9 kPa on 80% oxygen,...

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