Caso para diagnóstico

Abstract

WHAT IS YOUR DIAGNOSIS? CASE REPORTA 22-year old male patient presented with skin lesions on his face that had been becoming progressively worse over the previous four years. The patient had no relevant personal history of atopy, infection or trauma associated with the appearance of the skin lesions. At objective examination, multiple erythematous, purplish, shiny, hard papules and nodules were found, some with superficial erosion and crusting. They were situated unilaterally on the right side of his face in the preauricular area, tragus and external auditory canal (Figures 1 and 2). The remainder of the objective examination was normal, with no adenopathies or locoregional masses being found. The lesions were asymptomatic, albeit sporadically friable.The skin biopsy showed a dense infiltrate in the dermis associated with capillary proliferation with hyperplasia of the endothelial cells, which were swollen and protruding towards the vascular lumen (Figure 3).Laboratory evaluation, which included full blood count with differential white blood cell count, serum biochemical tests, measurement of immunoglobulin levels and urinalysis, was normal.Various forms of treatment were implemented, albeit unsuccessfully: tacrolimus ointment, topical and oral corticotherapy and oral isotretinoin; however the best results were obtained with electrocoagulation and CO2 laser.

Asymptomatic swelling on ear lobule of 1 year duration

“…The eosinophilia and high IgE levels are characteristic features of Kimura's disease, in ALHE these changes are generally absent. [ 8 ]…”