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Image in Dermatology
Erythema Elevatum Diutinum
Eritema elevatum diutinum
M. Mansilla-Poloa,b,
Autor para correspondencia
miguel_yecla96@hotmail.com

Corresponding author.
, R. Botella-Estradaa,b,c
a Department of Dermatology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
b Instituto de Investigación Sanitaria (IIS) La Fe, Valencia, Spain
c Universitat de València, Valencia, Spain
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        "titulo" => "Eritema elevatum diutinum"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 48-year-old woman with an unremarkable medical history presented with a 5-month history of 3 nodules on her left heel inner side &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A and B&#41;&#46; The 1&#8211;1&#46;5<span class="elsevierStyleHsp" style=""></span>cm nodules were erythematous&#44; semi-firm&#44; and minimally uncomfortable due to shoe friction&#46; Biopsy revealed the presence of a dense infiltrate on the dermis primarily composed of neutrophils&#44; plasma cells&#44; and eosinophils&#46; Leukocytoclastic vasculitis and collagen proliferation around the vessels &#40;angiocentric&#44; or onion skin storiform fibrosis&#41; on the superficial and deep dermis were evident &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C and D&#41;&#46; To confirm the histopathological differential diagnosis and rule out other spindle cell neoplasms&#44; immunohistochemistry was performed with S100 and CD34&#44; which tested negative&#46; Laboratory analyses included complete blood cell count&#44; biochemistry&#44; antinuclear antibodies &#40;ANA&#41;&#44; complement levels &#40;C3 and C4&#41;&#44; antineutrophil cytoplasmic antibodies &#40;ANCA&#41;&#44; C-reactive protein&#44; angiotensin-converting enzyme &#40;ACE&#41;&#44; protein electrophoresis&#44; and immunoelectrophoresis&#44; all of which yielded normal&#44; or negative results&#46; Thoracic X-ray was unremarkable&#46; A diagnosis of erythema elevatum diutinum &#40;EED&#41; was achieved&#44; and dapsone treatment initiated with favorable progress&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">EED is a rare dermatosis marked by recurrent papulonodules in extensor areas&#46; In advanced stages&#44; it can present as a late nodular variant that can mimic multiple skin neoplasms&#46; Histopathologically&#44; it exhibits leukocytoclastic vasculitis&#44; dense neutrophil infiltrates&#44; and collagen proliferation around the vessels &#40;storiform or onion skin fibrosis&#44; which are also present in other entities such as facial granuloma or IgG4 disease&#41; leading to fibrotic regions&#46; Leukocytoclastic vasculitis can be seen only in its early stages&#46; In this late nodular variant&#44; it is sometimes necessary to use immunohistochemistry techniques for the differential diagnosis of other spindle cell neoplasms&#44; especially CD34 &#40;to rule out dermatofibrosarcoma protuberans&#41;&#44; and S100 &#40;to rule out sclerotic neurofibroma&#44; among others&#41;&#46; Similarly&#44; it is necessary to differentiate it from other entities such as leiomyoma&#44; or superficial nodular fasciitis&#46; Associations with conditions like rheumatoid arthritis&#44; systemic lupus erythematosus&#44; chronic myeloid leukemia&#44; or monoclonal gammopathy should be ruled out&#46; Dapsone is the preferred treatment&#46;</p></span>"
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ISSN: 00017310
Idioma original: Inglés
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