A 72-year-old white woman of German heritage presented with a 30-year history of several painful lesions on the left side of her body. Clinical examination revealed numerous tender, erythematous papules and nodules over her left chest, flank, and lower extremity (Figure 1). The patient’s medical history was significant for hyperlipidemia, multiple uterine leiomyomas status after hysterectomy in 1972, and severe coronary artery disease status after coronary artery bypass grafting in 2004. The patient emigrated from Germany shortly after World War II; familial medical history was not available. Her medications were aspirin, warfarin, duloxetine, pregabalin, and atorvastatin. A shave biopsy was performed from a characteristic papule on the left lower extremity. Routine hematoxylin-eosin–stained sections are shown in Figure 2 and Figure 3.
Ramirez-Fort MK, Doan HQ, Nguyen HP, Khan F, Kauffman J, Campbell LS. Chronic Unilateral Eruption of Painful, Erythematous Papules and Nodules. JAMA Dermatol. 2013;149(7):865-866. doi:10.1001/jamadermatol.2013.3358