Visceral Disturbances in Patients With Cutaneous Lesions of the Erythema Group

In several papers under a title similar to the one which I have chosen for the chairman's address to the Section on the Practice of Medicine, Sir William Osler1collected a group of cases presenting a variety of symptoms but having in common skin lesions of the erythema group. Much interest attaches to cases of this type. Often diagnostic errors are made in them, especially when the skin lesions do not occur in close relation to the visceral manifestations. Puzzling combinations of symptoms appear, some of an almost fulminant type. Abdominal symptoms may lead to needless exploratory operations. Hematuria may suggest nephritis or renal neoplasm, etc. Renal changes analogous to those seen in the skin may lead to such a diminution of renal function as to cause uremia, or perhaps here there is an actual severe acute nephritis to which the skin lesions are secondary. The skin lesions are