Acta Dermato-Venereologica 99-9CompleteContent | Page 29

QUIZ SECTION Coral-bead Skin Lesions Associated with Erosive Arthritis: A Quiz Gloria ORLANDO 1 , Giovanna DAN 2 , Serena PEZZETTA 3 , Dennis LINDER 1 and Roberto SALMASO 4 1 Unit of Dermatology, Department of Medicine – DIMED, University of Padova, IT-35121 Padova, and 2 ULSS 6 Euganea, 3 Private Dermatological Practice, and 4 OUC of Histopathology, University of Padova, Padova, Italy. E-mail: [email protected] A 65-year-old Caucasian woman presented with nodular erythematous lesions on her hands. The lesions had ap­ peared approximately 10 months previously. She reported itch and intermittent pain and swelling of the finger joints (Fig. 1). Proximal interphalangeal, metacarpophalangeal, wrist, elbow and knee arthralgias, together with magnetic resonance imaging (MRI) showing an erosive arthropathy, and a negative test for rheumatoid factor and anti-cyclic ci­ trullinated peptide antibodies had previously led to a pre­ sumptive diagnosis of seronegative polyarthritis. Clinical examination revealed multiple reddish-brown, firm, non-scaly, non-tender papules and nodules 2–20 mm in diameter over the dorsum and sides of the fingers. Dermo­ scopy of the lesions revealed an orange-reddish background colouration with central paler yellow deposits. Around the proximal nail-folds, the papules had a “coral bead” appea­ rance. The patient had restricted mobility; she was unable to completely open or close either hand. There were no further relevant cutaneous findings and no mucosal involvement. Skin biopsy from a nodule on the right hand demonstrated a dermal dense infiltrate composed mainly of multiple mul­ tinucleated giant cells and histiocytes with a ground-glass aspect. These cells stained positively with CD68 (Fig. 2). What is your diagnosis? See next page for answer. Fig. 1. (a) Multiple reddish-brown, firm, non-scaly, non-tender papules and nodules on the right hand of a 65-year-old Caucasian woman. The lesions have a “coral bead” appearance around the proximal nail-folds. (b) Dermoscopy revealed an orange-reddish background colouration with central paler yellow deposits. Fig. 2. Histological features: (a) dermal dense infiltrate composed mainly of multiple multinucleated giant cells and histiocytes (haematoxylin and eosin (H&E) stain 1.5×), (b) ground-glass aspect (H&E 10×). 844 doi: 10.2340/00015555-3210 Acta Derm Venereol 2019; 99: 844–845 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica.