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A man with erythematous nodules: What is the diagnosis?

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A man with erythematous nodules: What is the diagnosis?
Alan Pascoal Silva Santos MD, Beatriz Rodrigues Silva Selles MD, Eloísa Leis Ayres MD, Marcus Henrique de Sousa Brito Xavier MD, Mayra Carrijo Rochael MD
Dermatology Online Journal 15 (6): 10

Universidade Federal Fluminense, Rio de Janeiro, Brazil.

Case synopsis

A 65-year-old man noted two asymptomatic and hypopigmented macules on his right arm and forearm six years prior to presentation, which disappeared one year later. About that time, painful nodules appeared on his upper and lower limbs associated with gynecomastia, sporadic epistaxis, and swelling in the distal lower limbs with hyperpigmentation. He consulted several physicians without a definitive diagnosis.

Figure 1 Figure 2

Physical examination revealed several erythematous-violaceous nodules and plaques on the upper (Fig. 1) and lower limbs, madarosis (Fig. 2), slight gynecomastia, facial and earlobe infiltration (Fig. 3), herniation of the iris in the left eye, and hepatosplenomegaly.

Figure 3 Figure 4

The findings of routine blood chemistry and CBC including peripheral blood, kidney and liver functions, were within normal limits. Slit smear bacilloscopy from earlobes and elbow were negative.

A skin biopsy specimen was taken from left arm and leg (Fig. 4).

What is your diagnosis?


© 2009 Dermatology Online Journal