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October 2009

Orange-Yellow Diffuse Cutaneous Eruption in an 82-Year-Old Woman—Quiz Case

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Arch Dermatol. 2009;145(10):1183-1188. doi:10.1001/archdermatol.2009.213-a

An 82-year-old woman presented with orange-yellow patches and plaques over her arms and trunk of 4 years' duration. The patient denied pruritus, pain, or any skin symptoms associated with this eruption. There was no history of night sweats, weight loss, fatigue, fever, weakness, or bone pain. On physical examination, there were numerous yellow plaques on her eyelids and diffuse orange-yellow patches on her arms and trunk (Figure 1). The lesions were symmetrically distributed. A shave biopsy specimen from her left back was obtained (Figure 2). Serum protein electrophoresis revealed monoclonal IgG κ protein, and the diagnosis of a monoclonal gammopathy of unknown significance was established. Test results from a bone marrow biopsy specimen were within reference range. Two years after the initial presentation, she developed painful violaceous subcutaneous lesions on her arms and trunk adjacent to her unchanged orange-yellow patches from initial presentation. A punch biopsy specimen from her right flank was obtained (Figure 3).

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