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JAMA Dermatology Clinicopathological Challenge
March 2018

Hyperpigmented Cutaneous Plaques With Ulceration on the Legs

Author Affiliations
  • 1Queen’s University School of Medicine, Queen’s University, Kingston, Ontario, Canada
  • 2Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
  • 3Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
JAMA Dermatol. 2018;154(3):355-356. doi:10.1001/jamadermatol.2017.4485

An 82-year-old Chinese woman presented with a 6-month history of a nonhealing ulcer and multiple indurated plaques on the legs. The first lesion appeared as an erythematous papule, which grew and subsequently ulcerated. Within a few months, she developed other indurated plaques on her legs. The ulcer was painful on palpation, but the plaques were mostly asymptomatic. The patient did not have fevers, chills, weight loss, dyspnea, chest pain, cough, or hemoptysis. She had moved to Canada from China 30 years ago and was unsure about tuberculosis (TB) exposure and Bacillus Calmette–Guérin vaccine status. Her medical history included atrial fibrillation, type 2 diabetes mellitus, dyslipidemia, cerebrovascular disease, hypertension, and Parkinson disease. Physical examination showed a 5 × 4-cm, well-demarcated, oval ulcer with a violaceous, dusky border and central yellow fibrin mixed with granulation tissue on the left lateral aspect of the calf (Figure, A). There were numerous violaceous to dull red, indurated plaques on the posterior aspect of the legs (Figure, B). Wound cultures were negative for bacteria, mycobacteria, and fungi (Figure, C and D).

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