Acta Dermato-Venereologica 99-10CompleteContent | Page 36

941 Ulceronecrotic Lesions in a Man with Familial Mediterranean Fever: A Quiz Ferdinand TOBERER and Martin HARTMANN Department of Dermatology, Venereology and Allergology, University Medical Center, Ruprecht-Karls-University, Im Neuenheimer Feld 440, DE-69120 Heidelberg, Germany. E-mail: [email protected] A 36-year-old man presented with a 10-month history of painless ulceronecrotic lesions on his left upper arm and right thigh. Clinical examination revealed an ulceration measuring 4×4 cm, with a fibrinous base, crust-covered bor- ders and a surrounding livid erythema, on his left upper arm (Fig. 1a). The right thigh showed a necrotic papule covered by a brownish crust (Fig. 1b). The patient had familial Medi- terranean fever (homozygous M694V mutation), which was treated with colchicine (1.5 mg/day). Laboratory analysis, including blood count, metabolic panel, hepatitis B/C, EBV and HIV serologies, was unremarkable. C-reactive protein values (34.8 mg/l) and erythrocyte sedimentation rate (32 mm/1 st h) were slightly elevated. A skin biopsy from the Fig. 1. Clinical picture. (a) Left upper arm. (b) Right thigh. arm was performed and revealed a dense dermal infiltrate composed of histiocytes, lymphocytes, multinucleated giant cells, plasma cells and neutrophils, forming tuberculoid and suppurative granulomas (Fig. 2). Focally, vessels showed signs of luminal obliteration and vasculitis. What is your diagnosis? See next page for answer. Fig. 2. Section of biopsy from the arm, showing a mixed dermal infiltrate forming granulomas (haematoxylin-eosin stain; original magnification ×100). QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3232 Acta Derm Venereol 2019; 99: 941–942