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JAMA Dermatology Clinicopathological Challenge
April 2015

New Tender Nodules After Arthroscopy

Author Affiliations
  • 1Department of Dermatology, University of Missouri–Columbia, Columbia

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

JAMA Dermatol. 2015;151(4):441-442. doi:10.1001/jamadermatol.2014.4872

A woman in her 20s with a medical history significant for systemic lupus erythematosus (SLE) presented with tender erythematous nodules after undergoing right knee arthroscopy (Figure, A). SLE had been diagnosed ten years previously after she presented with a positive antinuclear antibody titer (most recent titer, 1:1280), arthralgias, leukopenia, oral ulcers, and a malar erythematous eruption. There was no history of discoid or tumid lupus lesions. Initially, the lesions were thought secondary to soft-tissue infection and were treated with courses of clindamycin, vancomycin, and doxycycline. Physical examination revealed poorly demarcated erythematous plaques and nodules, tender to palpation, ranging from the distal thigh to the lower leg, adjacent to arthroscopy sites. Lesions around the suture sites appeared more violaceous. A punch biopsy of the lesion was performed (Figure, B and C).