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Case Reports
. 2021 Sep 23;13(9):e18214.
doi: 10.7759/cureus.18214. eCollection 2021 Sep.

Atypical Presentation of Erythema Elevatum Diutinum in a Patient With Hashimoto's Disease

Joanne S Jacob  1 , Jaime Tschen  2
Affiliations
Case Reports

Atypical Presentation of Erythema Elevatum Diutinum in a Patient With Hashimoto's Disease

Joanne S Jacob et al. Cureus. .

Abstract

Erythema elevatum diutinum (EED) is a cutaneous vasculitis that is characterized by histopathologic findings of neutrophilic infiltration, vessel fibrosis, and leukocytoclasia. It most often presents as papules, plaques, and nodules on the extensor surfaces of the extremities. Herein, we present a case of a 44-year-old woman with Hashimoto's disease with an atypical presentation of EED on the palmar surface of the thumb, in addition to the classic appearance on the elbow. Diseases associated with EED, including autoimmune conditions, are discussed.

Keywords: autoimmune; diutinum; elevatum; erythema; hashimoto’s; leukocytoclasia; vasculitis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Clinical picture of papules on the palmar surface of the thumb.
Distant (A) and closer (B) views of the palmar surface of the thumb. White arrows point to the painful skin-colored papules on the surface of the right thumb.
Figure 2
Figure 2. Clinical picture of nodules and plaque on the elbow.
Clinical image of the lesions on the extensor surface of the elbow. The black arrow points to the painful brown and violaceous plaque. The white arrows point to the two hard painful brown and violaceous nodules on the extensor surface of the left elbow.
Figure 3
Figure 3. Dermoscopy of a papule on the thumb.
Dermoscopy of one lesion on the thumb displays uniform coloring. The white arrow points to the 0.3-millimeter by 0.3-millimeter area of hyperkeratosis on the papule. The black arrows point to the pinpoint vessels.
Figure 4
Figure 4. Histopathology of a lesion on the elbow.
Multiple views of histopathology of a single lesion on the elbow at 10× (A), 100× (B), and 200× (C) magnification. White arrows point to areas of fibrin deposition and fibrous tissue around vessels. White asterisks mark areas of inflammatory infiltration. Asterisks in an image (C) demonstrate most clearly the neutrophilic fragmentation seen in leukocytoclastic vasculitis. Overall, slides demonstrate necrotizing vasculitis with leukocytoclasis and prominent fibrosis of dermal blood vessels.
See this image and copyright information in PMC

References

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