REPORT OF A CASE
A 41-year-old woman presented with a 1-year history of reddish nodules (width, 3 to 5 mm) on the dorsal aspect of her hands and fingers, predominantly near the interphalangeal joints and with periungual papules. The lesions developed insidiously and were asymptomatic (Figs 1 and 2). However, her finger joints were slightly painful with movement. Findings from her physical examination were otherwise within normal limits, and laboratory investigations were not contributory. A roentgenogram of her hand showed eroded articular surfaces and epiphyseal notches (arrow) in the area of the distal interphalangeal joints (Fig 2). She gave a history of having hyperthyroidism (Graves' disease) diagnosed in 1985 and was treated for 8 months with carbimazole. A biopsy specimen of a nodule was obtained and showed a polymorphous granulomatous dermal infiltrate composed of histiocytic cells and multinucleate giant cells with a periodic acid—Schiff—positivecytoplasm (Figs 3 and 4).
Moreau E, Truchetet F, Friedel J, Grandidier M, Cuny JF. Unusual Digital Nodules. Arch Dermatol. 1992;128(6):847-848. doi:10.1001/archderm.1992.01680160131021