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November 1996

Localized Indurated Brown Plaques on Arms and Right Buttock

Arch Dermatol. 1996;132(11):1369-1370. doi:10.1001/archderm.1996.03890350111019

REPORT OF A CASE  A 30-year-old woman presented with a history of having received intramuscular pentazocine injections in July 1992 in both deltoid muscles and on the right buttock. She stated that soon thereafter the skin overlying the injected sites became ecchymotic and indurated, and the size of the affected areas progressively increased. One year later, she began to experience pain at the injection sites, and bilateral hand edema developed. A magnetic resonance imaging study of both shoulders revealed bilateral axillary adenopathy and fibrous replacement of the subcutaneous fat.Her medical history was significant for iron deficiency anemia and endometriosis, which was diagnosed via laparoscopy in July 1992. Peritonitis developed as a consequence of laparoscopy, requiring a laparotomy and intramuscular pentazocine injections for pain. Present medications included butorphanol inhaler for pain. The patient denied a history of substance abuse.Physical examination revealed a 9×11-cm, illdefined, hyperpigmented, indurated plaque overlying the

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