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SCLEREDEMA (1997 Uniformed Services Dermatology Seminar, Case#23) presented by: Jay L. Viernes, Maj, USAF, MC, FS

Cirivello MJC - MedPix

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: SCLEREDEMA (1997 Uniformed Services Dermatology Seminar, Case#23) presented by: Jay L. Viernes, Maj, USAF, MC, FS

History: presented complaining of a two month history of increasing tightness of his skin overlying his cheeks, neck, chest, shoulders, back, upper arms, abdomen, and thighs. He reported no involvement of his hands, lower legs and feet. He had been able to continue performing regular physical fitness activities, but was noting increasing difficulty due to the tightening around his shoulders and neck. The patient reported having a history of infectious mononucleosis followed by a beta hemolytic strep throat infection approximately six to eight weeks before noting his skin tightening. The patient was otherwise healthy. He denied any family history of diabetes or connective tissue disease.

Exam: PHYSICAL EXAM: The patient's skin was extremely taut with marked, non-pitting, symmetric induration over his cheeks, lateral and posterior neck, chest, upper back and shoulders extending down the upper arms, abdomen, and upper anterior and lateral thighs. There was no sharp line of demarcation noted between involved and uninvolved areas. There was no tenderness, and he maintained full range of motion. His hands, buttocks, and lower legs were spared. Also noted were diffuse follicular papules and perifollicular erythema over his cheeks, neck, upper back, upper arms, and upper chest. Heart sounds were normal. Speech and swallowing was normal. LABORATORY: Normal fasting glucose. Elevated ASO titer; documented positive beta-streptococcal throat culture. Normal CBC without eosinophilia; normal electrolytes, liver enzymes, BUN, creatinine. Normal aldolase and creatinine kinase. Normal ESR; ANA negative. Serum protein electrophoresis (SPEP) normal with no evidence of monoclonal peaks. Normal electrocardiogram. HISTOPATHOLOGY: Incisional biopsy, left posterior upper arm: extremely thickened dermis with thick, non-hyalinized collagen bundles separated by large interfascicular spaces; sweat glands were seen in the mid-dermis. There were decreased numbers of fibroblasts. Special stains for mucin (colloidal iron) revealed evidence of increased mucopolysaccharides. Findings were consistent with scleredema.

No MeSH data available.


SCLEREDEMA
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MPX1606_synpic16696: SCLEREDEMA


SCLEREDEMA (1997 Uniformed Services Dermatology Seminar, Case#23) presented by: Jay L. Viernes, Maj, USAF, MC, FS

Cirivello MJC - MedPix

SCLEREDEMA
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1606&req=5

MPX1606_synpic16696: SCLEREDEMA

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: SCLEREDEMA (1997 Uniformed Services Dermatology Seminar, Case#23) presented by: Jay L. Viernes, Maj, USAF, MC, FS

History: presented complaining of a two month history of increasing tightness of his skin overlying his cheeks, neck, chest, shoulders, back, upper arms, abdomen, and thighs. He reported no involvement of his hands, lower legs and feet. He had been able to continue performing regular physical fitness activities, but was noting increasing difficulty due to the tightening around his shoulders and neck. The patient reported having a history of infectious mononucleosis followed by a beta hemolytic strep throat infection approximately six to eight weeks before noting his skin tightening. The patient was otherwise healthy. He denied any family history of diabetes or connective tissue disease.

Exam: PHYSICAL EXAM: The patient's skin was extremely taut with marked, non-pitting, symmetric induration over his cheeks, lateral and posterior neck, chest, upper back and shoulders extending down the upper arms, abdomen, and upper anterior and lateral thighs. There was no sharp line of demarcation noted between involved and uninvolved areas. There was no tenderness, and he maintained full range of motion. His hands, buttocks, and lower legs were spared. Also noted were diffuse follicular papules and perifollicular erythema over his cheeks, neck, upper back, upper arms, and upper chest. Heart sounds were normal. Speech and swallowing was normal. LABORATORY: Normal fasting glucose. Elevated ASO titer; documented positive beta-streptococcal throat culture. Normal CBC without eosinophilia; normal electrolytes, liver enzymes, BUN, creatinine. Normal aldolase and creatinine kinase. Normal ESR; ANA negative. Serum protein electrophoresis (SPEP) normal with no evidence of monoclonal peaks. Normal electrocardiogram. HISTOPATHOLOGY: Incisional biopsy, left posterior upper arm: extremely thickened dermis with thick, non-hyalinized collagen bundles separated by large interfascicular spaces; sweat glands were seen in the mid-dermis. There were decreased numbers of fibroblasts. Special stains for mucin (colloidal iron) revealed evidence of increased mucopolysaccharides. Findings were consistent with scleredema.

No MeSH data available.