Reddish brown papules and nodules on the hands: Case report
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An otherwise healthy 63-year-old woman presented with a three months history of weight loss, malaise and abdominal pain as first symptoms, followed by backpain, proximal muscle weakness and symmetrical painful decapacitating arthritis of the small joints of the hands. On physical examination reddish-brown papules and nodules were found on the dorsum of the fingers, some periungual in line.

On the neck and anterior chest was noticeable a photo-distributed pink, violaceous erythema with telangiectasias. In the follow-up period ovarian cancer was found. Punch biopsy of a nodule was performed. Multicentric reticulohistiocytosis was the likely diagnosis.

It is a rare non-Langerhans-cell-histiocytosis, characterized by brown papulonodular cutaneous eruption and destructive arthritis. 11% of all MRH patients have skin manifestation resembling of those of dermatomyositis: Gottron’s papules, a heliotrope rash, a V- neck sign and a shawl sign with one important clue that splits MCRH-like DM from classic DM being pruritus. Malignancy is the most common association of MRH (in 25 – 31% of cases).

Methotrexate is the most effective treatment as it controls both arthritis and skin lesions. It is considered as first choice of treatment.

Source: https://www.jaadcasereports.org/article/S2352-5126(20)30875-4/fulltext?rss=yes
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