PATHOLOGY QUIZ CASE 1
Edward H. Stolar, MD, the George Washington University Medical Center, Washington, DC
A 57-year-old woman had a four-year history of multiple painful plaques and nodules over the joints of her hands, elbows, and knees. She had occasional joint pain but denied weakness or fatigue. She had been treated with topical fluocinonide 0.05% twice daily for eight months without benefit.
Physical examination revealed hyperkeratotic, hyperpigmented tender nodules as well as a solitary annular plaque with an erythematous elevated border over the joints of her hands (Fig 1). There were similar nodules over her knees and elbows, and her arms and legs exhibited multiple patches of hyperpigmentation.
Abnormal laboratory findings included an ESR of 56 mm/hr and a hemoglobin level of 10.8 g/dL. An assay for antinuclear antibodies and serum protein electrophoresis findings were normal. Microscopic sections from one of the skin nodules are shown in Figs 2
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