PMC5422832_01
Multiple papules and nodules along with the superficial venous lines on the flexor (a) and extensor aspects of the right forearm (b). The newly developed lesions along the peripheral cephalic veins of the right (c) and (d) left forearms. Transcutaneous ultrasonography showing hypoechoic masses that surround the superficial vein, as indicated by yellow arrows (e, f).
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F1
Of note, the skin nodules clustering on the forearms tended to overlie exclusively the median basilica, cubital, or cephalic veins (Fig. 1a, b). These lesions showed fluctuation during his clinical course, irrespective of the skin sites of periodic blood sampling and insulin injection, and further extended along the peripheral venous lines of his forearm skin (Fig. 1c, d). Transcutaneous ultrasonography of the forearm lesions revealed demarcated, homogeneous, hypoechoic areas surrounding superficial veins, suggestive of peri-/intravascular granuloma (Fig. 1e, f).
a Histopathology showing nonnecrotic, noncaseation granuloma in the deep dermis and adipose tissue. HE. x10. b A high-power view of the dermal granuloma with relatively low inflammatory cell infiltrations. HE. x200.
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F2
The histopathology showed a nonnecrotic, noncaseating epithelioid granuloma with a relatively lower infiltration of inflammatory cells in the lower dermis and adipose tissue (Fig. 2).
Positron emission tomography screening exhibited BHL (a) and a solitary mass in the left gluteus minimus muscle (b), as indicated by orange arrows.
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F3
Bilateral hilar lymphadenopathy (BHL) and a solitary mass in the left gluteus minimus muscle were detected on positron emission tomography screening (Fig. 3a, b, respectively).
Disappearance of the abdominal skin lesion with topical steroid therapy (a) and persisting recurrence of the forearm skin lesions along with superficial venous lines (b, c).
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F4
During 1 year of follow-up, his abdominal skin lesion almost diminished with topical steroid therapy (Fig. 4a), but the forearm skin lesions often recurred along the venous lines (Fig. 4b, c).