January 2007

Fig.1

Fig.2

History :
84 year old African American woman was admitted for "chronic cellulitis" over 2 to 3 months. The patient complained of "knots" in the arms and legs, also complained of leg pain and ulcers.
Past Medical History:
Nephrotic syndrome, hypertension, peptic ulcer disease and anemia.
Medication:
Her current medication included prednisone 15 mg everyday.

Physical Examination:
Revealed multiple verrucous and crusted papules, plaques on bilateral arms and legs. There is also a 5 cm ulceration on the left lower leg. There are multiple tender nodules as well (figure 1 and 2).
An incisional wedge biopsy was performed on the right arm.

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