Back issues No.3 - 2002 / Resident Forum  

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Multiple Pruritc Hyperkeratotic Papules in a Patient with End-stage Renal Disease
Chang-Yu Tsai Chieh-Hsun Chen Heng-Leong Chan Tseng-Tong Kuo
Dermatol Sinica 20: 264-265, 2002

A 51-year-old man, a hepatitis-C virus carrier with diabetes and end-stage renal disease, was referred to the Dermatology Clinic with a 3-month history of pruritic eruption involving the scalp initially, gradually increasing in number, and becoming generalized. He had a poor-controlled DM for more than 20 years and was complicated by diabetic retinopathy, which was treated by photo-coagulation. He was hypertensive and in end-stage renal failure in 1999. He started hemodialysis since then. In September 2001, he was admitted to the hospital for the management of cholestasis induced by herbal medicine. His family history was unremarkable.
On examination, he had multiple erythematous, partly hyperpigmented papules which were 0.5cm in diameter and with central adherent keratotic plugs (Fig. 1). The scalp, trunk, and the extensor surfaces of the extremities were affected. Some of the lesions showed linear distribution.
Laboratory investigations revealed a blood urea nitrogen level of 112.5 mg/dl, a creatinine level of 6.9 mg/dl and a fasting glucose level of 250 mg/dl. Liver function tests revealed an AST level of 35 U/L, and an ALT level of 12 U/L. He was also positive for anti-hepatitis C virus antibody.
A biopsy was taken and the tissue specimen was stained with H & E (Fig. 2), Masson's trichome stain (Fig. 3) and Orcein stain (Fig. 4).

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