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PG FORUM
Year : 2012  |  Volume : 7  |  Issue : 2  |  Page : 108-110

What is your diagnosis?


1 Department of Dermatology and Venereology, Banaras Hindu University, Varanasi 221005, India
2 Department of Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi 221005, India

Correspondence Address:
Kajal Manchanda
Department of Dermatology and Venereology, Banaras Hindu University, Varanasi 221005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.1016/j.injr.2012.04.012

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Thirty five year old female presented with severe joint pain involving knees, elbows, wrists, small joints of hands and lumbosacral spine for 3 years along with multiple skin colored, asymptomatic nodules scattered over her body for last 6 months. On examination, there were multiple discrete but grouped, firm, skin colored, non tender papules and nodules, ranging in size from 2 mm to 2 cm over multiple sites mainly involving trunk and bilateral upper limbs. Systemic examination was within normal limits. Routine blood investigations were normal except for raised Eryth- rocyte sedimentation rate (31 mm/h). Radiographs of bilateral hands showed erosive arthritis in left index, left middle, right index and right little finger. Punch biopsy from a nodule over dorsum of hand on histopathological examination showed circumscribed large focus of diffuse dense infiltrate of large histiocytes and histiocytic giant cells with the scattering of lymphocytes and few neutrophils. Thus the diagnosis of Multicentric Reticulohistiocytosis was confirmed. The patient was started on 30 mg prednisolone with 15 mg of methotrexate orally once a week. The patient noticed improvement in the joint symptoms but there was no improvement in cutaneous lesions.


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