History: 67 y/o WF with blue nodules present on her left shin for one week. She denies any recent trauma and states that the lesions are slightly itchy but not painful or tender to the touch. She is currently completing a Medrol dose pack prescribed by her PMD for these nodules.
Past Medical History: Multiple Myeloma s/p autologous stem cell transplant in 2001, prurigo nodularis, hypertension.Medications: Lisinopril, Carvedilol, Gabapentin, Warfarin, Furosemide, Clobetasol ointment.
Physical exam: subcutaneous bluish/purple 4-10mm nodules at dorsal surface of the LLE (Figs.1&2).
Laboratory/imaging: Cr 1.36 mg/dL, Plt 165 K/mcL, Hb 10.5 g/dL, IgG 1760 mg/dL, IgM 73.5 mg/dL, IgA 29.5 mg/dL, Ig Kappa free light chain 14.0 mg/dL, Ig Lambda free light chain 182 mg/dL.
Click here for the Diagnosis.