ENIDGILBERT-BARNESSMDFrom the Departments of Pediatrics (Dr Kappy) and Pathology (Drs Tyson and Caldwell), The Children's Hospital, Denver, Colo; and The Children's Clinic (Dr Kummer) and The Billings Clinic (Dr Kleman), Billings, Mont.
THE PATIENT was a 9-month-old boy who had abnormal findings on an initial newborn screen for hypothyroidism, but a second test showed a normal circulating free thyroxine concentration, with serum thyroid-stimulating hormone concentrations that fluctuated between normal and slightly elevated. He was given replacement thyroid hormone to treat his compensated primary hypothyroidism. During the first few months of life, purplish, firm, nodular lesions were noticed on his abdomen and extremities (Figure 1), with the largest on the wrist and the knee (Figure 2). A biopsy specimen of one of the lesions on his abdomen had the microscopic appearance shown in Figure 3.
Kappy M, Kummer M, Tyson RW, Caldwell S, Kleman G. Pathological Case of the Month. Arch Pediatr Adolesc Med. 1999;153(4):427-428. doi: