PMC7091481_01
Grouped bluish-purple nodules and papules on the flexor area of the right shin.
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On admission, grouped bluish-purple nodules and papules were present on the flexor area of the right shin (Fig. 1).
Osteochondral outgrowth in the medial part of the tibia on a computed tomography scan.
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X-ray examination of the right lower leg demonstrated an osteochondral outgrowth in the medial part of the tibia which was also visualized with a computed tomography (CT) scan (Fig. 2).
A dense neutrophilic infiltrate with histiocytes, multinucleated giant cells and neutrophils locally forming microabscesses (hematoxylin and eosin, original magnification x 4) (A). Enlarged area marked on previous image - microabscess with leukocytoclasis within the vessel wall (hematoxylin and eosin, original magnification x 20) (B). Multinucleated giant cells within the inflammatory infiltrate (arrowheads) (hematoxylin and eosin, original magnification x 40) (C).
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Histological assessment of the skin biopsy revealed edema of the papillary and reticular dermis, proliferation of small vessels, and a dense neutrophilic infiltrate with histiocytes, a few multinucleated giant cells and neutrophils forming microabscesses locally (Fig. 3).
The lesions from Fig. 1 after 7 intravenous pulses of methylprednisolone - mostly postinflammatory hyperpigmentation with only a few active lesions is seen.
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In the meantime, methylprednisolone pulse therapy resulted in significant improvement of existing skin lesions (Fig. 4).