PMC9827444_01
a, b Flesh to pink colored papules and nodules with scale on the dorsum of the fingers with involvement of the nail folds.
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F1
Physical exam revealed multiple fleshes to pink colored papules with a central puncta-like quality, both discreet and coalesced, on the extensor surface of the digits of the right and left hand with distorted 4th and 5th DIP joints (Fig. 1).
Plain film of right hand with erosive changes in the fourth and fifth DIP joints.
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F2
Review of plain films of the hands (Fig. 2) revealed erosive changes with soft tissue swelling to several DIP and proximal interphalangeal joints bilaterally.
a, b H&E stained section of biopsy demonstrating histiocytes and Touton-type multinucleated giant cells with abundant eosinophilic cytoplasm and a "ground glass" appearance. x100 and x400 magnification.
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F3
The cytoplasm of the cells had an eosinophilic "ground glass" appearance, consistent with changes of reticulohistiocytosis (Fig. 3). The biopsy was initially interpreted as a xanthogranuloma, but upon discussion of the clinical and radiographic features with the dermatopathologist, the formal diagnosis of MRH was made.