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January 2007

Atrophic Macules and Soft Papules in a 24-Year-Old Woman—Quiz Case

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Arch Dermatol. 2007;143(1):109-114. doi:10.1001/archderm.143.1.109-b

A 24-year-old woman presented with a 2-year history of round and oval atrophic lesions with a wrinkled overlying surface (Figure 1) and whitish soft papules (Figure 2) localized on the chest, upper back area, and upper extremities. Her medical history was unremarkable except for photosensitivity. A complete laboratory evaluation showed lymphocytopenia (lymphocytes, 0.9×103/μL; reference range, 1.5-4.5×103/μL), hypocomplementemia (C3, 0.43 g/L [reference range, 0.93-1.88 g/L]; and C4, 0.06 g/L [reference range, 0.15-0.48 g/L]), and positive antinuclear (1/80 speckled pattern) and anticardiolipin (IgG, 20.2 PGLU/mL [polyclonal rabbit anti–human IgG units per milliliter] [reference value, <10 PGLU/mL]; and IgM, 29.2 MGLU/mL [polyclonal rabbit anti–human IgM units per milliliter] [reference value, <8.5 MGLU/mL]) antibody titers. A biopsy specimen from a representative lesion was stained with hematoxylin-eosin (Figure 3) and Verhoeff–van Gieson (Figure 4) stains.

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