|
| Patient | Age | Sex | Clinical presentation | Histology | Diagnosis | Comorbidities | Serum findings | Treatment/response |
|
| 1 | 70 | F | Nodular lesions on external surface of thighs
Erythematous papules and plaques on back of the hands and fingers (Figure 1(f)) | First biopsy (thigh): loosely arranged lymphocytes and histiocytes scattered in superficial and middermis with focal mucin deposits (Figure 2(f))
Second biopsy (hands): necrobiosis area surrounded by a rim of peripheral palisading histiocytes, lymphocytes, and multinucleated giant cells associated with a slight perivascular inflammatory infiltrate in superficial and middermis | First biopsy: IGD
Second biopsy: GA | Sjogren syndrome
Arthralgia
Hypoacusis
Type 2 diabetes
Hashimoto’s thyroiditis
Pleuritis | ANA 1 : 2560
SS-A, SS-B | In treatment with hydroxychloroquine 200 mg/die
Methotrexate 7.5 mg/week added
Improvements with no CR |
| 2 | 68 | M | Nonconfluent, skin-coloured papules of 2-5 mm diameter located on the hips, gluteus, axillae, and inner surface of upper limbs with mild itching (Figure 1(a)) | Gluteus skin biopsy: interstitial and perivascular lymphocytes and histiocytes dispersed among the collagen fibers and focal mucin deposits (Figure 2(a)) | IGD | Polymyalgia rheumatica
Arthralgia
Psoriasis
Macular degeneration | ANA 1 : 320 | Topical steroids with partial response |
| 3 | 42 | F | Erythematous papules confluent in ring-like fashions with central resolution located on the thighs, arms, and axillae (Figure 1(d)) | Lymphocytes and histiocytes dispersed among collagen fibers (Figure 2(c)) | GA, incomplete/interstitial form | Arthralgia
Allergic rhinitis | ANA 1 : 160
Hypergammaglobulinemia | Hydroxychloroquine and topical steroids |
| 4 | 75 | F | Erythematous papules, some with annular disposition, located on the thighs (Figure 1(e)) | Moderate lympho-histiocytic inflammatory infiltrate in superficial ad middermis, with perivascular and interstitial distribution among degenerating collagen fibers and mucin deposits (Figure 2(d)) | GA, incomplete/interstitial form | Sjogren syndrome
Hypothyroidism
Osteoporosis
Colon diverticulosis
Gallstones | ANA 1 : 640
SS-A
IgM monoclonal gammopathy | — |
| 5 | 65 | F | Slightly erythematous and confluent nodules localized on the elbows and back of the hands (Figure 1(b)) | Hand skin biopsy: lymphocytes, histiocytes, and several multinucleated giant cells in a palisading pattern surrounding areas of degenerated collagen fibers and mucin in the superficial dermis (Figure 2(b)) | GA, necrobiotic pattern | Sjogren syndrome | ANA 1 : 80 | — |
| 6 | 70 | F | Brownish hardened patches, roundish, and confluent with a slightly hypopigmented central area, located on inner surfaces of the thighs (Figure 1(c)) | Thigh skin biopsy: limpho-histiocytic dermal infiltrate surrounding degenerated collagen areas and perivascular (Figure 2(e)) | GA, necrobiotic pattern | Arthralgia | ANA 1 : 160
Hypogammaglobulinemia | Hydroxychloroquine plus topical steroids CR in six months
Arthralgia resolved |
|
