PMC3937488_01
Skin-colored nodules over the knuckles
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F1
A 50-year-old male presented with firm skin-colored and erythematous nodules over the knuckles, elbows, buttocks, knees, and lower legs which gradually increased in size in since 3 years duration [Figure 1].
Neutrophilic vasculitis with leucocytoclasia (H and E, x400)
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F2
Biopsy of the nodules of the knuckles showed focal parakeratosis and mild spongiosis in the epidermis, perivascular neutrophilic infiltrate in the dermis, neutrophils in the vessel wall and leukocytoclasia [Figure 2].
Linear IgA deposits in the basement membrane zone
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F3
Immunofluorescence showed linear IgA deposits in the basement membrane zone and weak granular perivascular C3 and fibrinogen deposits [Figure 3].
Dermal papillary microabscess (H and E, x400)
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F4
Biopsy of the vesicular lesions were consistent with dermatitis herpetiformis [Figure 4].