PMC10113061_01
(a) Right and (b) left auricular involvement characterized by purplish redness and swelling of the pinna but sparing the lobules.
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fig1
He had swelling and tenderness of both auricles sparing the lobules (Figure 1) and erythematous and tender nose.
Erythematous, flat-topped, hyperkeratotic papules on the dorsal metacarpophalangeal joints bilaterally (gottron papules).
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fig2
Skin examination showed gottron papules (Figure 2), erythematous plaques overlying the knees and elbows, bilateral nontender subcutaneous nodules in the olecranon area, and patchy alopecia.
Biopsy of the posterior aspect of the right elbow showing perivascular lymphohistiocytic infiltration without lichenoid changes (hematoxylin and eosin stain, 100x).
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fig3
Skin biopsy of the elbow disclosed lymphocytic inflammatory infiltrates at the dermal-epidermal junction basement membrane and perivascular lymphocytic infiltrates without lichenoid changes with positive mucin in alcian blue stain consistent with DM (Figure 3).
Erythematous fingertip papules.
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fig4
However, gottron papules and subcutaneous nodules persisted, and he began presenting with painful fingertip papules (Figure 4).
Resolution of (a) fingertip papules and (b) gottron papules after rituximab therapy.
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fig5
Three months after rituximab treatment, gottron papules, subcutaneous nodules, and fingertip papules resolved (Figure 5).