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JAMA Dermatology Clinicopathological Challenge
July 2013

Multiple Slowly Growing Nodular Lesions on the Lower Legs in a 78-Year-Old Obese Woman

Author Affiliations
  • 1Georg-August-University, Göttingen, Germany

Copyright 2013 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Dermatol. 2013;149(7):867-868. doi:10.1001/jamadermatol.2013.3377a

A 78-year-old woman presented with a 3-year history of slowly growing painless nodular lesions on both legs that were refractory to topically applied corticosteroids. On physical examination there were approximately 20 erythematous waxy plaques and nodules on edematous lower legs (Figure 1). Twenty years prior, the patient had undergone hysterectomy and adnexectomy followed by radiation for treatment of endometrial cancer. Thereafter, she experienced chronic lymphedema of both legs. Furthermore, the patient has chronic heart failure (NYHA class III), obesity (body mass index [BMI], 32 [calculated as weight in kilograms divided by height in meters squared]), arterial hypertension, and type II diabetes mellitus. For 60 years she had been receiving thyroid hormone therapy with levothyroxine sodium (currently 100 µg/d) for treatment of hypothyroidism. She did not have a history of Graves disease. Results of laboratory investigations, including routine blood tests, tests of liver enzymes, renal function, and thyroid profile, serum protein analysis, immunoglobulin levels, and autoantibody profile were within normal limits. Venous duplex ultrasonography excluded a relevant chronic venous insufficiency. A punch biopsy sample of the lower leg was obtained (Figure 2 and Figure 3).

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