UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Joanne K. Simpson MD, MPH, Joseph C. English III MD, Jonhan Ho, MD, Drazen M. Jukic, MD, PhD
AUGUST 2006 CASE OF THE MONTH
CLINICAL FINDINGS
A 57 year-old female with a 1-year history of autoimmune presented violaceous, indurated plaques on the dorsal aspects of both feet. These plaques presented several months after she was diagnosed with autoimmune hepatitis and caused mild restriction of her ankle mobility. In addition, on her bilateral thighs she had multiple, small, discrete erythematous scaly patches which developed one month prior to presentation.
She had been receiving azathioprine and prednisone for her autoimmune hepatitis since the time of her diagnosis and her hepatitis has been stable. However, despite being on these immunosuppressive medications, her cutaneous findings did not resolve. She was referred by her gastroenterologist and rheumatologist for biopsy.
Review of her past medical history is significant autoimmune hepatitis, inflammatory polyarthritis, and hypothyroidism. Her blood work revealed normal antinuclear antibody (ANA), Anti-centromere antibody, complements 3 &4, anti-topoisomerase antibody (Anti-Scl 70), anti-Jo-1 antibody titers. Her liver functions tests were all with normal limits. An elevated TSH level was detected, which is consistent with her thyroid disease. Her review of systems is remarkable for limited mobility of the affected ankles. She denied any joint pain, muscle weakness, evidence of cutaneous calcinosis, Raynaud’s disease, dysphagia for solids or liquids, or gastroesophageal reflux disease.
On examination, the patient had a large violaceous thickened plaques on the dorsal aspect of her feet (Figures 1 & 2). There were also multiple small vascular erythematous patches with minimal scale on her thighs (not photographed).
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