PMC5577088_01
Erythematous rash of the patient. The distribution of the erythema resembles the V-neck sign.
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A physical examination revealed diffuse erythema on the forehead, neck, shoulders, upper arms, and anterior chest (Fig. 1).
A small red to flesh-colored nodule on the dorsum of the right middle finger (arrowhead).
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In addition, a biopsy of a solitary red nodule on the dorsum of the right middle finger (Fig. 2), which was initially considered trivial, showed similar histologic findings to the forehead skin with infiltration of numerous multinucleated foreign-body giant cells.
Numerous multinuleated giant cells and slight lymphocyte infiltration. The nuclei are arranged haphazardly or clustered at the center. The cells have prominent nucleoli and pale cytoplasm (periodic acid-Schiff staining, x400).
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These cells had pale ground-glass cytoplasm and were positive for periodic acid-Schiff staining (Fig. 3), positive for CD68, and negative for S-100 protein.