Blue plaque on the chest: A sign of systemic disease☆

An 83-year-old woman presented to the dermatology clinic for her annual full body skin examination. She had a medical history of hypertension, coronary artery disease, hypercholesterolemia, anxiety, Hashimoto’s thyroiditis, gastroesophageal reflux, osteoarthritis, and actinic keratosis. The patient had no complaints or concerns about her skin other than a casual mention of a blue-tinted discoloration on her chest, which she noted had been present for several months and was gradually worsening. The patient’s surgical history included prior coronary artery bypass grafting (CABG) 5 years ago, hysterectomy, left knee replacement, and removal of benign breast tumors. She was a retired entrepreneur who did not smoke, drink alcohol, or use illicit drugs. Her medications included low-dose aspirin, losartan, furosemide, fluvastatin, omeprazole, oxazepam, potassium chloride, metoprolol succinate, and vitamins C and D. She was allergic to atorvastatin, chlordiazepoxide, ciprofloxacin, clarithromycin, latex, lorazepam, temazepam, and trazodone. Her family history included a daughter with thyroid cancer and ovarian cancer. A review of her systems revealed recent shortness of breath, cough, an inability to wear her necklaces because they had become too tight, and a change in the quality of her voice.