UPMC Dermatopathology "Case of the Month" Presentations
UPP - Department of Dermatology, Dermatopathology Unit
Lori Spencer MD, PhD, Nicole Prall, MD, Drazen Jukic, MD, PhD, Joseph English, MD
SEPTEMBER 2007 CASE OF THE MONTH
CLINICAL FINDINGS
42 year old Caucasian male with past medical history significant for insulin dependent diabetes mellitus was referred from an outside dermatologist for “tough skin” on the posterior neck and upper back, which had been present for ten years. Due to this “tightness,” his skin did not form folds with movement of the neck, back, and shoulders. He reported no associated symptoms other than stiffness. Specifically, he had no respiratory or cardiac complaints. He had been previously biopsied by an outside dermatologist, yielding nonspecific findings, and a deeper biopsy was recommended.
Physical Exam:
The patient was well developed, well nourished, and in no apparent distress. The skin of the posterior neck and upper back was firm, indurated, and mildly erythematous (Figure 1). He had no other cutaneous findings.
Laboratory investigations:
CBC, LFT, BUN, and serum creatinine were normal. ANA was 18. RPR was nonreactive. HbA1c was 6.9. Serum protein electrophoresis was normal.
Histology:
We performed a deep wedge biopsy of the posterior neck. Histology revealed an unaffected epidermis with a dramatic increase in dermal thickness. There was dermal fibrosis and edematous spaces between collagen bundles (Figures 2-4), corresponding to hyaluronic acid (mucin) deposition (Figures 5-6).
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