Skin lesions in a patient with epilepsy.

To cite: Tidman A, Jones R, Holme SA. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014207893 DESCRIPTION A 63-year-old woman presented with two smooth, firm, flesh-coloured lumps protruding from the nail folds of her left third and fifth toes (figures 1 and 2). She had a background of epilepsy but had never previously undergone neuroimaging. Periungual fibromas are an important sign of tuberous sclerosis complex, an autosomal dominant multisystem disorder characterised by hamartomas in multiple organs, including skin, brain, eyes, kidney and heart. Skin lesions are found in approximately two-thirds of cases, and also include facial angiofibromas (‘adenoma sebaceum’), the shagreen patch and ash leaf-shaped white macules. This patient had a definitive diagnosis of tuberous sclerosis made after a CT brain scan demonstrated subependymal nodules. Despite advances in neuroimaging, it is still important to perform a general examination of the skin, particularly the feet and hands, in any patient presenting with seizures.