PMC6586134_01
Left arm, antecubital area, discrete, multiple well-demarcated, edematous, erythematous papules and plaques.
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Physical exam was significant for diffuse joint tenderness without swelling or warmth, and multiple raised, blanchable, erythematous papules and plaques distributed on the back, arms, legs, and face, as well as leonine facies (Figures 1 and 2).
Face, frontal view. Leonine facies: Diffuse skin infiltration, multiple nodular lesions.
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Physical exam was significant for diffuse joint tenderness without swelling or warmth, and multiple raised, blanchable, erythematous papules and plaques distributed on the back, arms, legs, and face, as well as leonine facies (Figures 1 and 2).
Histopathology, skin biopsy, taken from left arm. H&E staining 200 x magnification showing non-caseating granulomatous dermatitis.
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Interestingly, skin punch biopsy revealed non-caseating granulomatous dermatitis, with negative stains for atypical mycobacteria, tuberculosis and fungal organisms (Figure 3).
Trends in WBC, serum creatinine, and albumin-corrected calcium over 10 hospital days. There is sustained improvement in WBC, creatinine, and calcium levels after administration of oral prednisone, as noted on hospital day 6.
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The hypercalcemia resolved with steroids, fluid resuscitation, calcitonin, and pamidronate which also led to the improvement of renal function (Figure 4).