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Off-Center Fold
February 2013

Subcutaneous Nodules on the Fingers—Quiz Case

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD; LORI D. PROK, MD

JAMA Dermatol. 2013;149(2):223. doi:10.1001/archderm.149.2.223-d

A 52-year-old black man presented with 2 slowly enlarging, mildly painful subcutaneous nodules, one on the left second finger and one on the right fourth finger. His primary care physician had treated the nodules as arthritis with ibuprofen, without improvement.

Physical examination revealed 2 firm subcutaneous nodules, one located on the ulnar aspect of the right forth finger, adjacent to the proximal interphalangeal joint (Figure 1), and the other located distal to the proximal interphalangeal joint on the left second finger (Figure 2). Radiographic imaging of the hands showed loss of the corticomedullary junction of the left second middle phalanx and right fourth proximal phalanx, with adjacent soft-tissue swelling. Skin biopsy specimens were obtained from both nodules and submitted for histologic examination (Figure 3).

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