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Diagnostic Dilemma: Skin Disease

Diagnostic Dilemma: Skin Disease

Pruritic papulo-nodular eruption

A 35-year-old woman was admitted to the hospital in January 2006, presenting with generalized pruritic cutaneous papules and nodules. Her current medications included acyclovir and pantoprazole.

Physical examination revealed a well-appearing young woman in no acute distress. She was afebrile with normal vital signs. The exam showed numerous mild erythematous papules and nodules distributed on the trunk and extremities (see Figures 1A and 1B). There was no lymphadenopathy. The liver and spleen were not palpable. There was no sternal tenderness. The remainder of the physical examination was unremarkable.

Laboratory evaluation showed white blood cell count of 9.3 109/L and hemoglobin of 10.1 g/dL. Comprehensive chemistry panel was normal except for mildly elevated AST 69 U/L and LDH 196 U/L. A punch biopsy was performed (see Figures 2A and 2B).

1) The photographs reveal findings noted at the time of a diagnostic and therapeutic procedure. What is your diagnosis?

a) Drug-induced pseudolymphoma
c) Aleukemic myeloid leukemia syndrome cutis
b) Drug eruption
d) Lymphomatoid papulosis

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