A 78‐year‐old white woman presented with a 1‐year history of multiple skin nodules in the periorbital and temple areas. She had been diagnosed 6 years earlier with monoclonal gammopathy of undetermined significance and myelodysplasia. Her previous medical history included Alzheimer dementia, ischaemic heart disease, congestive cardiac failure, atrial fibrillation, hypertension, bilateral macular degeneration and breast cancer.Physical examination revealed multiple yellow plaques over the periorbital and temple areas, with xanthelasma‐like plaques over the eyelids (Fig. a).(a) Multiple, firm, yellow, dermal plaques in the peri‐orbital and temple areas, with xanthelasma‐like plaques over the eyelids; (b) resolution of the plaques following lenalidomide treatment.Blood tests showed normal renal function, a stable but profound pancytopenia secondary to myelodysplasia, erythrocyte sedimentation rate 118 mm/h (normal range 0–15 mm/h), a stable IgG paraprotein band of 20 g/L (7–16 g/L) and low C4 level. Urinary Bence–Jones protein and lytic lesions were not detected, and bone marrow trephine biopsy showed 8% clonal plasma cells.Histopathological examination of a biopsy taken from the patient's temple revealed a dense granulomatous infiltrate with epithelioid histiocytes, foamy histiocytes and scattered multinucleate giant cells, including Touton‐type giant cells. The infiltrate surrounded areas of necrobiosis containing cholesterol clefts (Fig. a,b).The appearances were consistent with a
Clinical & Experimental Dermatology – Wiley
Published: Jan 1, 2018
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