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September 20, 2010

Pruritic Indurated Plaques on the Legs of a 62-Year-Old Woman—Diagnosis

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Arch Dermatol. 2011;147(1):109-114. doi:10.1001/archdermatol.2010.401-b

Within the deep dermis there was an arteriole or small muscular artery that was packed with erythrocytes and contained fibrin (Figure 2 and Figure 3). Vascular inflammation was not identified. Focal lipophagic fat necrosis and a mild lymphocytic inflammatory infiltrate with scattered eosinophils were present within the subcutaneous tissue. A hematologist confirmed the diagnosis of PCV, with a peripheral blood analysis revealing JAK2 V617F point mutation. She responded well to hydroxyurea, 500 mg twice daily, and daily low-dose aspirin. Within a week her pain and pruritus subsided, and in 4 weeks her complete blood cell count had returned to normal. Skin lesions have improved with only residual hyperpigmentation.

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