Histopathologic examination revealed whorls of plump spindle cells in a background of slightly thickened collagen in the superficial dermis. Sparse numbers of lymphocytes were present around adjacent superficial capillary plexus vessels.
The papules and arthritis persisted for more than 6 months after the diagnosis was made, despite therapeutic trials of low-dose oral prednisone and nonsteroidal anti-inflammatory agents. The patient was referred to a physical therapist for maintenance of joint mobility and has been unavailable for further follow-up.