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JAMA Oncology Clinical Challenge
February 21, 2019

Multiple Cutaneous Nodules and Limb Swelling

Author Affiliations
  • 1Department of Dermatology, Venereology and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
  • 2Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
JAMA Oncol. 2019;5(6):902-903. doi:10.1001/jamaoncol.2018.6982

A man in his 30s presented with painless swelling of the left upper limb and nodules on the left side of the chest and abdomen. The lesions had started a month previously as red nodules on the left axilla, ipsilateral chest, and back. Twenty days later, he developed edema in the left upper limb. While being evaluated for the cutaneous lesions, the patient was diagnosed with AIDS and began antiretroviral therapy.

On examination, 6 erythematous, firm, subcutaneous nodules were present on the left side of the chest, abdomen, and left upper limb, varying in size from 2 × 2 cm to 4 × 4 cm (Figure, A). There was diffuse erythema and edema on the left upper limb, leading to difficulty in limb movement (Figure, A). Multiple dilated superficial vessels were present on the posterior aspect of the left arm and ipsilateral chest wall. Left axillary lymph nodes were grossly enlarged, firm, nontender, and nonmatted, with the largest lymph node measuring 6 × 4 cm. The patient’s CD4 cell count was 141/μL (to convert to ×109/L, multiply by 0.001), and his HIV load was 504 473 copies/mL. A skin biopsy sample was obtained from the plaque and sent for histopathologic examination (Figure, B and C).