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January 2009

Erythematous Papules on the Legs—Diagnosis

Author Affiliations
 

MICHAEL E.MINGMD, MSCE

 

CARRIE ANN R.CUSACKMDSENAIT W.DYSONMDJACQUELINE M.JUNKINS-HOPKINSMD

Arch Dermatol. 2009;145(1):77-82. doi:10.1001/archdermatol.2008.556-b

Findings from microscopic examination demonstrated amorphous, eosinophilic material in the dermal papillae and reticular dermis, including around the blood vessels and appendages. The material was stained with periodic acid–Schiff. Laminin, type IV collagen, and CD34 expression were noted in the perivascular deposits, and anti-IgM labeled the amorphous substance. Electron microscopy revealed capillaries surrounded by electron-dense, finely granular material consistent with immunoglobulin deposits. Microscopic findings were consistent with IgM storage papules. His serum viscosity ratio was 2.1 (reference range, 1.4-1.8).

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