A 32-year-old woman presented with a 1-year history of hypopigmented nodules on her trunk and extremities. One month earlier, she had been seen by the neurosurgery service for progressively severe headaches. Magnetic resonance imaging showed obstructive hydrocephalus, and an intraventricular shunt was placed.
Physical examination revealed hypopigmented, indurated 1- to 2-cm nodules distributed on the patient's face, trunk, and extremities (Figure 1). The results of the following laboratory tests were normal: chemistry panel, hematocrit, serum calcium levels, and urinalysis. Liver enzyme and angiotensin-converting enzyme levels were elevated. An electrocardiogram showed normal sinus rhythm. A 3-mm punch biopsy specimen of skin was obtained from the patient's arm (Figure 2).
Chiang JK, Ortiz-Ferrer LC, Remlinger K, Bronson DM. Subcutaneous Nodules in a Patient With Hydrocephalus. Arch Dermatol. 2002;138(2):259-264. doi:10.1001/archderm.138.2.259