Rare presentation of erythema elevatum diutinum
Erythema elevatum diutinum (EED) is a rare, chronic, and progressive skin condition, classified within the neutrophilic vasculitides. It presents as erythematous and violaceus papules and plaques. Published in the Journal of American Academy of Dermatology, the authors present a rare case of EED in terms of its severity and the high functional impact it caused.

An 83-year-old man presented with voluminous and extensive painless nodules on his limbs. He had neglected the lesions for more than 3 years, and they gradually spread and grew, making prehension and everyday gestures strenuous. The patient was otherwise fit and well.

Physical examination found raised, well-defined, deforming violaceus hard nodules. These were distributed on the palms, on both anterior and posterior sides of the fingers, and on the elbows, knees, and soles. Results of laboratory tests including full blood count, renal function, and liver profile were within normal range. HIV, hepatitis B and C serology were negative. Electrophoresis of serum proteins showed the presence of a monoclonal IgG λ (8 g/L; normal limits, 0.4-4.2 mg/L).

A punch biopsy for hematoxylin-eosin was performed and showed a dermal nodule made of a dense neutrophilic infiltrate admixed with large collagen bundles and neoangiogenesis.

Together with the distribution and clinical features, histology supported the diagnosis of EED. To start dapsone, the patient underwent a glucose-6-phosphate dehydrogenase screening, which found an enzymatic deficiency; therefore, the drug was contraindicated. He was then lost to follow-up.

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