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JAMA Dermatology Clinicopathological Challenge
April 2018

Tender Nodules on the Lower Legs

Author Affiliations
  • 1Division of General Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
  • 2Division of Anatomic Pathology, Children’s Hospital of Philadelphia, Perelman School of Medicine, Philadelphia, Pennsylvania
  • 3Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston
JAMA Dermatol. 2018;154(4):471-472. doi:10.1001/jamadermatol.2017.4878

A man in his 20s with panhypopituitarism, septo-optic dysplasia, developmental delay, duodenal stricture, and a history of pancreatitis presented with a painful eruption on his bilateral lower legs. The patient was well until 2 days prior to hospitalization when he developed bilateral lower extremity edema. The day prior to admission, he developed painful pink lesions on both legs. He had not applied any topical medications to his legs or had recent exposure to hot tubs or fish tanks at the home. He had a history of keratosis pilaris on the lower legs and was otherwise well with no fevers, recent upper respiratory infections, abdominal pain, vomiting, or diarrhea.

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