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JAMA Dermatology Clinicopathological Challenge
January 2015

Tender Leg Nodules in a Hospitalized Patient

Author Affiliations
  • 1Department of Dermatology, University of Texas Southwestern Medical Center, Dallas
  • 2Cockerell Dermatopathology, Dallas, Texas
JAMA Dermatol. 2015;151(1):95-96. doi:10.1001/jamadermatol.2014.2727

A man in his 60s was admitted to the hospital for an 8-day history of abdominal pain, bloating, vomiting, diarrhea, subjective fever, weight loss, and fatigue. He also complained of multiple tender red lesions on his bilateral ankles and legs that appeared 2 days prior to admission. Findings from a review of systems were negative for cough, sore throat, history of hepatitis, tuberculosis, sarcoidosis, inflammatory bowel disease, or sulfonamide use.

Physical examination revealed several ill-defined, exquisitely tender erythematous subcutaneous nodules on his bilateral shins, medial feet, ankles, and right lower thigh without overlying ulceration, necrosis, or drainage (Figure, A and B). A punch biopsy was performed, demonstrating pathognomonic histopathologic findings (Figure, C and D).