Back issues No.2 - 2012 / Resident Forum  

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Multiple hypertrophic purpuric to erythematous papuloplaques on four limbs of a 38-year-old man
Yung-Yi Lee, Jui-Hung Ko, Mei-Ching Lee, Jheng-Wei Lin

A 38-year-old healthy man presented with a 6-month history of mildly pruritic skin lesions on joints of four limbs. Initially, the itchy erythematous papules developed from extensor aspects of the joints, then the papules gradually progressed to violaceous plaques. He denied any trauma history or chronic scratching on the cutaneous lesions. On physical examination, there were multiple purpuric to erythematous hypertrophic, oval-shaped, and well-demarcated plaques with varying size on the extensor aspects of the left second and third metacarpophalangeal joints, left elbow, and bilateral knees (Figure 1). The initial clinical diagnosis was lichen planus or lichen simplex chronicus. Skin biopsy revealed marked hyperkeratosis, hypergranulosis, moderate acanthosis, and thickened dermal vessels infiltrated and surrounded by many neutrophils, and scattered eosinophils and lymphocytes. Nuclear dusts and focal mild extravasation of red blood cells with some vessels surrounded with fibrin deposits were seen (Figure 2). No bacilli are detected by Gram and Warthin-Starry stains.

Erythema elevatum diutinum (EED).

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