Adult multiple xanthogranulomas with spontaneous resolution.

Abstract

A 60-year-old Taiwanese woman was referred in August 1999 for evaluation of multiple papules. Two months earlier, she first noted a reddish papule on her left buttock. In the subsequent 2 months, multiple similar lesions developed on her back, abdomen, chest and face. The patient had a history of hypertension for 9 years, diabetes mellitus for 8 years and atrial fibrillation for 3 years, and had undergone a hysterectomy 9 years earlier because of uterine leiomyoma. There was no pertinent family history of similar cutaneous lesions. At onset of the skin lesions, the patient was taking Tenormin (atenolol) at 100 mg daily, Capoten (captopril) 25 mg t.i.d., Apresoline (hydralazine) 50 mg t.i.d., and Euglucon (glyburide) 5 mg t.i.d. for more than 3 years. On physical examination about 20 dome-shaped, smooth-surfaced, yellowish to erythematous papules measuring 2to 5-mm were revealed on her face, trunk and buttocks (Fig. 1a). Neither cafe-au-lait spots nor other signs of neurofibromatosis were noted. The laboratory examinations, including a complete blood count, urinalysis, liver function tests and renal function tests, were all within the normal range. The patient’s serum lipid profile, showing total cholesterol 168 mg/dl (normal range: 130 – 220 mg/dl), LDL-C 99 mg/dl (normal range: v150 mg/dl), HDL-C 51 mg/dl (normal range: w35 mg/dl) and triglycerides 89 mg/dl (normal range: v200 mg/dl), was also within normal limits. A chest X-ray and an ophthalmological examination were also normal. A skin biopsy specimen of a yellowish papule showed a dome-shaped nodular infiltration of foamy histiocytes admixed with many Touton giant cells and lymphocytes in the papillary and reticular dermis (Fig. 2). Some eosinophils were also noted. The epidermis was flattened with a collarette at the periphery. Stain for S-100 protein revealed no staining of the tumor cells. After the patient’s first visit, similar new lesions continued to develop. Physical examination at her follow-up visit in November 1999 revealed 58 lesions scattered over her face, trunk, buttocks and proximal thighs. A second skin biopsy specimen was obtained from a new lesion. Infiltration of histiocytes was found in the dermis admixed with lymphocytes. The histiocytes showed fewer foamy changes than those in the previous biopsy, and some Touton giant Fig. 1. Several yellowish to erythematous papules on the right buttock (a). The papules resolved with residual hyperpigmentation one year after their onset (b).