UPP - Department of Dermatology, Dermatopathology Unit
Laura Ferris, MD, PhD, J. Gabriel Vasquez, MD, Jonhan Ho, MD, J. Manuel Zarandona, MD
MAY 2009 CASE OF THE MONTH
A 46-year old white female with Graves Disease, hypertension, and rosacea presented to our clinic for a four-month history of several confluent erythematous and painful nodules over her right tibia. She was treated empirically with antibiotics three times without improvement. In addition, she was given corticosteroids, both intralesionally and topically with the intention of treating her Graves’ dermopathy. At one point the patient’s methimazole was stopped to see if her symptoms would improve, but the pain persisted. She was otherwise well and had no systemic symptoms.
The patient had a 1.5x2cm area of confluent, red papules over her right tibia. The lesion was indurated and tender to light touch. The rest of her exam was unremarkable.
Tender erythematous nodules with minimal epidermal changes include: Eccrine spiradenoma, Neurilemmoma, Persistent arthopod bite or sting, Erythema Nodosum, Panniculitis, and Vasculitis.