Postictal Petechial Skin Rash (Trout Skin) After a First Epileptic Seizure in a 54-Year-Old Man

Area of Science:

• Neurology
• Dermatology

Background:

• Postictal petechiae, a rare finding, are associated with epileptic seizures.
• This rash, often called "trout skin," presents as pinpoint hemorrhages that don't blanch under pressure.

Purpose of the Study:

• To report a case of postictal petechiae in a patient experiencing a first-time epileptic seizure.
• To highlight the diagnostic utility of this rare sign in cases of unexplained loss of consciousness.

Main Methods:

• Case report of a 54-year-old male with new-onset loss of consciousness.
• Clinical examination, laboratory tests, computed tomography (CT), magnetic resonance imaging (MRI), and electroencephalography (EEG) were performed.
• Diagnosis was based on patient history, postictal state, tongue biting, and characteristic petechial rash.

Main Results:

• The patient presented with a petechial rash on the face, neck, and chest following a witnessed loss of consciousness.
• No neurological deficits, inflammation, or coagulation disorders were detected.
• Neuroimaging and EEG were unremarkable, leading to a diagnosis of a first epileptic seizure.

Conclusions:

• Postictal petechiae ("trout skin") are a rare but recognized sign associated with epileptic seizures.
• This dermatological finding can be a valuable clue for diagnosing seizures, especially when the presentation is atypical or history is limited.