UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Case Authors: P.C.Parham-Vetter, MD,MPH Douglas Kress, MD
MARCH 2004 CASE OF THE MONTH
FINDINGS
History:The patient was taking aspirin for her heart but no other prescription, over-the-counter, or herbal medications. She had no known medication allergies. She had no history of significant medical illness other than mild hypertension controlled by diet. She had a family history of diabetes and breast cancer.
Social history included a 25 year history of smoking ½ ppd. She worked part-time as a pet groomer and had frequent contact with pets. She also had frequent contact with several grandchildren who were elementary school age. She had no history of STDs, although she did have a history of multiple sex partners before marrying.
The patient reported a frequent cough, but otherwise the review of systems was unremarkable.
Exam:
Physical exam revealed annular and circinate lesions ranging in size from 2
cm in diameter to 8 cm in diameter. The lesions consisted of multiple 1-3 mm
slightly erythematous papules and were located on the dorsum of both arms and
hands, the anterior neck, chest and upper back. The skin and mucosal exam was
otherwise unremarkable.
Based upon the physical exam, the clinical differential diagnosis included tinea corporis, granuloma annulare, cutaneous T-cell lymphoma, annular lichen planus, sarcoidosis, secondary or tertiary syphilis.
Laboratory Tests:
Laboratory tests ordered by her primary care physician two weeks after the lesions
appeared included a CBC, electrolytes, lipid profile, hepatic profile, VDRL,
?Hcg, and fasting glucose. These tests were all normal. A KOH preparation performed
in our office was negative.
Histopathology:
A punch biopsy was performed with a 4mm trephine on a newly developed lesion
on the patient’s left forearm. The path findings are discussed in the
figure and image review page:
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