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October 2009

Orange-Yellow Diffuse Cutaneous Eruption in an 82-Year-Old Woman—Diagnosis

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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(10):1183-1188. doi:10.1001/archdermatol.2009.213-b

Histologic examination of patient's first skin biopsy specimen (Figure 2) revealed infiltrate of pale staining and foamy histiocytes in the superficial dermis. A few multinucleated histiocytic giant cells were identified. The diagnosis was interpreted as generalized DPX. Histologic examination of patient's second skin biopsy specimen (Figure 3) revealed necrobiotic foci with cholesterol clefts surrounded by a xanthogranulomatous infiltrate with Touton-type giant cells. These findings were consistent with NXG. Findings from a repeated bone marrow biopsy were negative for disease. Although there was no evidence of a hematologic malignancy, worsening of her cutaneous symptoms and persistence of monoclonal IgG protein level prompted empirical initiation of melphalan along with dexamethasone. On the follow-up, her xanthomas had improved and all of her painful subcutaneous nodules had resolved. In addition, her serum IgG levels had decreased.

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