PMC5958585_01
Crops of small, red-yellow dome-shaped papules of approx. 6 mm with well-defined borders located on the anterior medial thigh
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F1
Physical examination revealed multiple, nodular/firm pearly-yellow papules distributed bilaterally on the skin of the anterior thighs and on the right elbow [Figure 1].
Appearance of venous blood following phlebotomy, exhibiting a thick, milky supernatant
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F2
During routine phlebotomy, the patient's blood appeared lipemic with a thick, milky supernatant [Figure 2].
Biopsy photo showing changes of lichen simplex chronicus above collections of lipid-laden histiocytes and areas of extracellular lipid deposition, including cholesterol clefts. (H and E, x20)
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F3
A shave biopsy of the skin lesions revealed the collections of lipid-laden histiocytes and areas of extracellular lipid deposition, including cholesterol clefts, consistent with a diagnosis of eruptive xanthomatosis [Figures 3 and 4]. Additional stains and cultures for infectious organisms were all negative.
Within the dermis, there are somewhat nodular collections of lipid-laden histiocytes highlighted by a CD68 stain. Areas of extracellular lipid deposition are also seen including cholesterol clefts. (H and E, x100)
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F4
A shave biopsy of the skin lesions revealed the collections of lipid-laden histiocytes and areas of extracellular lipid deposition, including cholesterol clefts, consistent with a diagnosis of eruptive xanthomatosis [Figures 3 and 4]. Additional stains and cultures for infectious organisms were all negative.