SOONBAHRAMIMDCARRIE ANN R.CUSACKMDSENAIT W.DYSONMDMOLLY A.HINSHAWMDVINCENTLIUMD
Histologic examination revealed an intense perivascular and interstitial infiltrate of lymphocytes, histiocytes, and eosinophils with scattered granulomas, formed by histiocytes and multinucleated giant cells, palisading around collagen bundles. A medium-sized blood vessel showed inflammatory cells within its wall, fibrin deposition, and erythrocyte extravasation, consistent with vasculitis. Further laboratory evaluation showed an elevated rheumatoid factor of 595 U and elevated total IgE level of 1389 U, and was negative for antineutrophil cytoplasmic antibodies. A chest radiograph showed bilateral pulmonary infiltrates. Electromyography confirmed a bilateral sensory neuropathy. Treatment with prednisone was initiated at a dose of 1 mg/kg/d. The addition of mycophenolate mofetil failed to result in remission of her disease, and initiation of cyclophosphamide therapy is planned.
An Unusual Pruritic Eruption of the Feet—Diagnosis. Arch Dermatol. 2009;145(6):715–720. doi:10.1001/archdermatol.2009.108-b