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July 21, 2008

Nodular Eruption on the Feet, Knees, and Dorsal Surface of the Hands of a 34-Year-Old HIV-Positive Man—Diagnosis

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Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Dermatol. 2008;144(7):933-938. doi:10.1001/archderm.144.7.934-c

Hematoxylin-eosin–stained sections demonstrated nodular aggregates of spindle cells that were associated with thin collagen fibers in a patterned (lamellar/concentric) array. Furthermore, neutrophils, nuclear “dust,” and foci of extravasated erythrocytes were variably associated with fibrin deposits around small blood vessels. Further laboratory investigations demonstrated a hematocrit of 19% (reference range, 41%-53%), polyclonal hypergammaglobulinemia, and, notably, an absence of an IgG or IgA monoclonal gammopathy. Because of the patient's severe anemia, dapsone therapy, the first-line treatment for EED, was not initiated as it can cause dose-dependent methemoglobinemia and hemolysis. Colchicine therapy was begun at a dosage of 0.6 mg twice a day.

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