Ulcerated Plaque and Nodules on the Thigh of a Patient With Febrile Pulmonary Disease

REPORT OF A CASE  A 66-year-old woman was admitted with a four-month history of a painful indurated plaque on her left thigh, fever, arthralgias, and paresthesia of the legs. On examination, an indurated, ulcerated, violaceous plaque surrounded by some erythematous nodules was seen on her left thigh (Fig 1). Laboratory findings included an elevated erythrocyte sedimentation rate with a normal blood cell count, negative antinuclear antibodies, and a normal T4-T8 ratio. Renal function was normal. Otolaryngologic consultation did not reveal any abnormality. A bilateral interstitial symptomless pneumonia was seen on chest roentgenograms, and abdominal sonography revealed a nodule in the spleen but no lymphadenopathy. Computed tomographic scanning of the brain showed some opacities along the blood vessels.Histopathologic findings of a biopsy specimen of the skin plaque are shown in Figs 2 through 4. C3 deposits in the vessels of superficial and deep dermis were seen in direct immunofluorescence.