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Indurated Plaques on the Arms
Rebecca L. Smith, MD;
Frederick A. Leaf, MD
Virginia Mason Medical Center, Issaquah, Wash
Arch Dermatol. 2002;138:1371-1376.
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REPORT OF A CASE
A 56-year-old white man presented with asymptomatic indurated plaques
on the flexor aspect of his forearms. The eruption had begun 3 to 4 days after
the patient had an influenzalike illness (Figure 1). An initial biopsy specimen showed superficial and deep
dermal infiltrates, with plasma cells and eosinophils extending into lobular
septa, without vasculitis. Clinically, the process resembled erythema nodosum;
however, Borrelia infection was also suspected based
on the microscopic findings. The patient was treated with a combination of
penicillin and super-saturated potassium iodide (SSKI). Some softening of
the lesion occurred. The treatment with super-saturated potassium iodide was
discontinued owing to an increase in thyrotropin levels, and colchicine therapy
was begun but was later discontinued because of diarrhea. The findings of
a second biopsy were thought to be consistent with probable morphea, and calcitriol
therapy was initiated. By this time, . . . [Full Text of this Article]
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