Atypical Presentation of Erythema Elevatum Diutinum in a Patient With Hashimoto's Disease

Abstract

Erythema elevatum diutinum (EED) is a cutaneous vasculitis that is characterized by histopathologic findings of neutrophilic infiltration, vessel fibrosis, and leukocytoclasia. It most often presents as papules, plaques, and nodules on the extensor surfaces of the extremities. Herein, we present a case of a 44-year-old woman with Hashimoto's disease with an atypical presentation of EED on the palmar surface of the thumb, in addition to the classic appearance on the elbow. Diseases associated with EED, including autoimmune conditions, are discussed.

Erythematous Plaques on the Extensors of the Extremities in a Middle-aged Female

“…Initially, the lesions are soft, but eventually they fibrose and leave behind atrophic scars. [2] EED has been associated with autoimmune diseases such as rheumatoid arthritis, coeliac disease, inflammatory bowel disease, type 1 diabetes and relapsing polychondritis. Associations with infections, including Streptococcus, hepatitis, syphilis and HIV as well as malignancies such as hypergammaglobulinemia, IgA monoclonal gammopathy and myelodysplasia have also been suggested.…”

“…Cholesterol deposits in histiocytes and in the extracellular tissue, called 'extracellular cholesterolosis' may be present in older lesions, which is responsible for the yellow look of the lesions. [2] Clinical differentials of EED include Sweet's syndrome which presents as asymmetrical tender lesions located on the arms, face and neck. On the other hand, EED lesions are chronic, symmetrical and classically located over the dorsa of the hands and knees, buttocks and Achilles tendons.…”