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June 20, 2011

Erythema Nodosum–Like Lesions in a Renal Transplant Recipient—Quiz Case

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Copyright 2011 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2011

Arch Dermatol. 2011;147(6):735-740. doi:10.1001/archdermatol.2011.128-a

A 30-year-old woman presented with a 3-month history of multiple asymptomatic nodules on her lower limbs that were associated with low-grade fever, chronic diarrhea, headache, loss of appetite, and loss of weight. She had undergone a cadaveric renal transplantation 5 months earlier and was on an oral regimen of immunosuppressants.

Computed tomography of the brain showed an abscess in the left parietal lobe, and radiography of the chest showed a nodule in the right lower lobe. Blood, sputum, cerebrospinal fluid, and stool samples and cultures were negative for bacteria, viruses, mycobacteria, fungi, and parasites. Skin examination revealed multiple subcutaneous, erythematous, nontender, erythema nodosum–like lesions on the lower limbs (Figure 1). Skin biopsy specimens were sent for hematoxylin-eosin (Figure 2), bacterial, mycobacterial, and fungal stains.

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