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

BACKGROUND Postictal petechiae have a recognized but rare association with epileptic seizures, possibly due to increased capillary pressure and blood leakage. The appearance has been likened to that of trout skin, and the pinpoint skin petechiae retain their color even when pressure is applied. This report describes the case of a 54-year-old man with a postictal petechial skin rash (trout skin) following a first epileptic seizure. CASE REPORT A 54-year-old man arrived at our hospital's emergency room after experiencing a loss of consciousness for the first time. Except for slight disorientation, no focal neurological deficits were found. The only notable clinical abnormality was a petechial rash confined to the face, neck, and chest. Laboratory analysis showed no signs of inflammation or coagulation disorder. Further testing, including computed tomography (CT), magnetic resonance imaging (MRI), and electroencephalography (EEG), revealed no abnormalities. Based on the patient's history, postictal state, tongue biting, and the characteristic petechial rash, we diagnosed a first-time epileptic seizure. Antiepileptic therapy with levetiracetam was initiated. CONCLUSIONS This report highlights the known but rare association of postictal petechiae (trout skin) with epileptic seizures, which is a clinical sign that may assist the clinician in identifying a cause of loss of consciousness when the clinical history is unclear.