A 52-year-old man presented with a 3-week history of progressive, persistent, pruritic plaques that began on the posterior aspect of his right arm and subsequently developed on his left arm. Treatment with cephalexin and cetirizine was ineffective.
Two weeks prior to the development of the plaques, the patient was hospitalized with a 3-month history of abdominal pain. Admission laboratory findings revealed elevated alanine transaminase, aspartate transaminase, and alkaline phosphatase levels as well as increased prothrombin time. The patient underwent laparoscopic cholecystectomy for acute cholecystitis. Because of the increase in liver enzyme levels and abdominal pain, he received 7 subcutaneous injections (10 mg each) of phytonadione in the forearm and deltoid muscle as well as intramuscular injections of meperidine. His family history was significant for type 2 diabetes mellitus.
Gettler SL, Fung MA. Indurated Plaques on the Arms of a 52-Year-Old Man. Arch Dermatol. 2001;137(7):957-962. doi: