Late‐stage nodular erythema elevatum diutinum mimicking sclerotic fibroma

Abstract

Erythema elevatum diutinum (EED) is a rare, cutaneous vasculitis of uncertain origin. EED can present clinically as chronic bilateral, symmetrical, periarticular papules, plaques and nodules.We report here an unusual case of EED presenting as multiple, densely fibrosing nodules on the feet of a 60-year-old human immunodeficiency virus positive woman. The initial evaluation of the patient was complicated by the strong histologic resemblance of multiple lesions to sclerotic fibroma, a cutaneous manifestation of Cowden disease. Our case highlights the important features that distinguish these 2 pathologic entities.erythema elevatum diutinum, histopathologic mimicry, sclerotic fibroma, cutaneous vasculitis

Erythema elevatum diutinum a rare and poorly understood cutaneous vasculitis: A single institution experience

“…The typical distribution of the lesions in EED is usually bilateral and symmetrical on extensor surfaces of the limbs . In our series, patient #2 showed a granuloma annulare‐like lesion on the scalp; a very unusual location for EED lesions.…”

“…13,14 The typical distribution of the lesions in EED is usually bilateral and symmetrical on extensor surfaces of the limbs. 14,15 In our series, patient #2 showed a granuloma annulare-like lesion on the scalp; a very unusual location for EED lesions. Furthermore, the histological findings in this case is of a mixed perivascular granulomatous infiltrate (Figure 3), which corroborated the clinical impression.…”

Cutaneous manifestations of monoclonal gammopathy

“…With the progression of the disease, the papillary and periadnexal dermis become involved. Granulation tissue, xanthomatization, and storiform fibrosis are also seen [ 185 , 196 , 197 ]. Dapsone is the preferred first-line treatment and is associated with improvement of cutaneous and extracutaneous symptoms (although late nodular cutaneous lesions may be more recalcitrant to treatment).…”