Acta Demato-Venereologica 98-2CompleteContent | Page 34

299 Chronic Nodular Dermatosis: A Quiz Marco CUSINI, Stefano RAMONI, Vinicio BONESCHI and Sebastiano RECALCATI Unit of Dermatology, Department of Pathophysiology and Transplantation, Ca’ Granda Foundation and Institute for Research and Care, Mag- giore Polyclinic Hospital, University of Milan, Milan, Italy. E-mail: [email protected] A 29-year-old Egyptian man presented with a 6-month history of multiple papular nodular lesions on his limbs. Prior to admission to our department he had been treated with topical antibiotics and corticosteroids by other specia- lists, but with no resolution. On admission, he had multiple brownish papular nodular lesions, some with erosions and other with crusts, on his legs (Fig. 1a), and an erythematous ulcerated plaque on his left wrist (Fig. 1b). In addition, some slightly erythematous firm nodules were present on his face (Fig. 1c). The patient’s general condition was non- compromised, he only reported mild itching. He worked as a warehouseman at the vegetable market in Milan and had been in Italy permanently for 2 years. Serology for HIV and syphilis were negative. Neurological examina- tion documented a loss of sensation in the lesions on the lower limbs, with no palpable nerve enlargement. Biopsy specimens from the plaque on the left wrist were submitted for histology (Fig. 1d). What is your diagnosis? See next page for answer. QUIZ SECTION Fig. 1. Clinical presentation. (a) Multiple papular nodular crusted brownish lesions on the legs. (b) Ulcerated plaque on the left wrist. (c) Flesh- coloured firm non-tender nodules on the face. (d) Histopathology: section of diseased skin demonstrating thinned out epidermis with a grenz zone and underlying dermis demonstrating vacuolated and foamy interlacing histiocytes (haematoxylin and eosin (H&E) ×20). This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2828 Acta Derm Venereol 2018; 98: 299–300