PMC4448070_01
a, c Areas of induration on the posterior thighs (arrows; a) and painful peau d'orange-like eruptions on the left upper arm (c). b Distribution of cutaneous induration (red color). d T2-weighted MRI showed significantly thickened fascia of the lower extremities (arrowheads).
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F1
On initial consultation, multiple areas of glossy induration (fig. 1a) and painful peau d'orange-like lesions (fig. 1c) were observed on the chest and four extremities (fig. 1b). T2-weighted magnetic resonance imaging (MRI) showed significant hyperintense thickening of the fascia of the lower extremities (fig. 1d).
a, b Photomicrographs of the induration (hematoxylin and eosin stain; original magnification: a x100, b x200). Degeneration of the fascia (a) and muscle (arrows, b) with infiltration of lymphocytes and eosinophils were observed. c, d Immunohistochemical stains by antibodies to CD8 (c) and CD4 (d) showing predominant CD8+ T cell infiltration (original magnification: x400).
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F2
Histopathological examination of a biopsy specimen from an area of induration showed marked fibrinoid degeneration of the fascia (fig. 2a) and the neighboring muscle (fig. 2b) with mixed cellular infiltration of lymphocytes and eosinophils. Immunohistochemistry manifested predominant CD8+ lymphocytic infiltrates (fig. 2c) as well as a limited number of CD4+ lymphocytes (fig. 2d).