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September 2009

Erythematous Plaques Involving Calves—Quiz Case

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Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Dermatol. 2009;145(9):1053-1058. doi:10.1001/archdermatol.2009.183-a

A 51-year-old man presented with a 7-month history of mildly painful plaques involving his bilateral calves. Pertinent medical history included venous insufficiency, non–insulin-dependent diabetes mellitus and Graves disease with exophthalmos, treated with radioactive ablation in 2002. He had had normal thyroid gland function and had been receiving a stable dose of levothyroxine sodium for 3 years.

On physical examination, the patient had nonpitting, lightly erythematous plaques involving the posterior legs (Figure 1; the arrow indicates the Achilles tendon). There was no warmth, drainage, or excoriation. Punch biopsy specimens taken from his left calf were stained with hematoxylin-eosin (Figure 2) and Alcian blue (Figure 3).

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