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February 2013

Subcutaneous Nodules on the Fingers—Diagnosis

Author Affiliations
 

SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD; LORI D. PROK, MD

JAMA Dermatol. 2013;149(2):224. doi:10.1001/archderm.149.2.223-h

Biopsy specimens of both nodules showed noncaseating epithelioid granulomas in the subcutaneous tissue; no involvement of tendons was observed. Grocott methenamine-silver stains were negative for fungal elements, and Ziehl-Neelson stains were negative for acid-fast bacilli. Foreign bodies were not seen with polarized light.

The patient also had bilateral hilar and mediastinal adenopathy (observed on chest radiography), and the findings of biopsy of a subcarinal lymph node were compatible with sarcoidosis. Laboratory studies were notable only for a mild increase in angiotensin-I–converting enzyme (58 U/L; reference range, 8-52 U/L) (to convert to nanokatals per liter, multiply by 16.667). The patient later developed subcutaneous nodules on his trunk and arms, which responded well to treatment with topical and intralesional corticosteroids.

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