Violaceous Skin Reaction of the Hand

Mr. C is a 74-year-old male with colon cancer who originally was treated with surgery and 5-fluorouracil-based chemotherapy. One year after Mr. C completed treatment, paramedics were called to transport him to the emergency room (ER) after he experienced a grand mal seizure in his home. An 18-gauge catheter was placed in his right hand in the ambulance for IV access. He was given 10 mg IV diazepam en route to the ER to control his seizures; then, an IV bolus dose of 750 mg of phenytoin was administered in the ER. Once his seizures were controlled, Mr. C was admitted to the inpatient medical/oncology unit with a diagnosis of metastatic colon cancer with new onset of seizures. He was placed on a medication regimen of daily oral phenytoin and oral diazepam as needed.