UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Izikson, Leonid MD, Drazen M. Jukic, MD, PhD
NOVEMBER 2006 CASE OF THE MONTH
CLINICAL FINDINGS
51-year-old white female presented with a 4-day history of pruritic bumps that first appeared on the thighs and later on the rest of the lower extremities and on both upper extremities. The initial red color changed to dark purple over several days. This eruption was accompanied by worsening of arthralgias and morning stiffness. She had no fevers, child, or night sweats. She had a similar, but more mild eruption, 2 years ago. Past medical history includes arthritis nos, hypothyroidism, depression, and alcohol/benzodiazepine dependence. She presented on multiple medications. The lesions progressed to crusted papules over the 5 days of her admission without any therapy.
Tender, discrete violaceous and brown-black nodules on a purpuric base. No Janeway lesions, Osler’s lesions, subungual hemorrhages, or Roth spots. No ulcerations.
Histopathologic examination of a punch biopsy specimen revealed fibrinoid necrosis of vessel walls throughout the full thickness of the dermis (Fig 2), an interstitial inflammatory infiltrate of neutrophils and cellular debris, and necrosis of the epidermis with subepidermal vesiculation. Both PASD and Gram stains were negative.
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