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Nodular Eruption on the Feet, Knees, and Dorsal Surface of the Hands of a 34-Year-Old HIV-Positive Man—Diagnosis
Arch Dermatol. 2008;144(7):933-938.
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Diagnosis: Erythema elevatum diutinum (EED).
MICROSCOPIC FINDINGS AND CLINICAL COURSE
Hematoxylin-eosin–stained sections demonstrated nodular aggregates of spindle cells that were associated with thin collagen fibers in a patterned (lamellar/concentric) array. Furthermore, neutrophils, nuclear "dust," and foci of extravasated erythrocytes were variably associated with fibrin deposits around small blood vessels. Further laboratory investigations demonstrated a hematocrit of 19% (reference range, 41%-53%), polyclonal hypergammaglobulinemia, and, notably, an absence of an IgG or IgA monoclonal gammopathy. Because of the patient's severe anemia, dapsone therapy, the first-line treatment for EED, was not initiated as it can cause dose-dependent methemoglobinemia and hemolysis. Colchicine therapy was begun at a dosage of 0.6 mg twice a day.
DISCUSSION
EED is a rare but distinctive, chronic fibrosing leukocyoclastic vasculitis whose occurrence in the setting of HIV infection has been described elsewhere.1 The nodules may result from chronic antigen exposure and the inflammatory response that develops subsequent to antigen deposition within the skin.1 The nature of this antigen in HIV-infected . . . [Full Text of this Article]
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Nodular Eruption on the Feet, Knees, and Dorsal Surface of the Hands of a 34-Year-Old HIV-Positive Man—Quiz Case
Jeffrey S. Newman and Maxwell A. Fung
Arch Dermatol. 2008;144(7):933-938.
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