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JAMA Dermatology Clinicopathological Challenge |

Erythematous Papules and Plaques on the Cheeks QUIZ

Asuka Tsuji, MD1; Akane Minagawa, MD, PhD1; Ryuhei Okuyama, MD, PhD1
[+] Author Affiliations
1Department of Dermatology, Shinshu University School of Medicine, Asahi, Matsumoto, Japan
JAMA Dermatol. 2016;152(5):569-570. doi:10.1001/jamadermatol.2015.5252.
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A man presented with a 3-year history of recurring erythematous papules on the bilateral cheeks, despite topical steroid therapy, without any additional symptoms. Polyclonal hypergammaglobulinemia was found on serum protein electrophoresis. What is your diagnosis?

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A, Indurated papules and plaques are present on the lateral cheeks and behind the ears and neck along with a red-brown hue. B and C, Hematoxylin-eosin–stained skin biopsy specimens taken from papules show nodular inflammatory cell infiltration consisting of dense lymphocytes admixed with plasma cells and eosinophils. D, Papule specimen under IgG4 immunohistochemical stain.

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