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December 2003

Pruritic Erythematous Macules in a 72-Year-Old Woman—Diagnosis

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Arch Dermatol. 2003;139(12):1647-1652. doi:10.1001/archderm.139.12.1647-a

Microscopic examination of the toluidine blue–stained biopsy specimen showed a mild increase in the number of oval to spindle-shaped mast cells surrounding superficial dermal capillaries. The epidermis, which was somewhat hyperpigmented, otherwise appeared unremarkable. No eosinophils were noted.

Significant laboratory tests results included an elevated white blood cell count (62.1 × 103/µL [reference range (RR), 4.5-1.0 × 103/µL]) and elevated levels of eosinophils (14% [RR, 1%-5%]), alkaline phosphatase (227 U/L [RR, 38-126 U/L]), lactate dehydrogenase (1115 U/L [RR, 280-600 U/L]), serum urea nitrogen (29 mg/dL [10.4 mmol/L] [RR, 7-17 mg/dL (2.3-6.1 mmol/L)]), and creatinine (1.4 mg/dL [124 µmol/L] [RR, 0.5-1.0 mg/dL (44-88 µmol/L)]). Computed tomography of the abdomen and pelvis revealed that the spleen was at the upper limits of normal size and that the liver was slightly enlarged, with an irregularly contoured area of low attenuation. A thickened trabecular pattern and small areas of increased sclerosis involving the iliac and ischial bones were identified. A bone marrow biopsy specimen was generally hypercellular. Flow cytometry did not define an abnormal phenotype. However, cytogenetics showed trisomy of chromosome 8.

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