Multiple Firm Nodules and Tender, Indurated Plaques

Abstract

Aman in his 30swith a history of multiple medical conditions, includinghypertension, congestiveheart failure (receiving chronicdiuretic therapy), chronic renal insufficiency, andpulmonaryembolus (receiving warfarin therapy), presented with multiple firm nodules that extruded a thin, white, milky fluid within tender, hyperpigmented, induratedplaquesonthe lowerabdomen(Figure,A).Healso hadnumerous smallernondraining, yellow-whitenodulesonanerythematous to hyperpigmented base on the bilateral medial thighs (Figure, B). A few scattered firm, yellow-white subcutaneous nodules were also seen on the extensor upper extremities. The lesions appeared approximately 1 year prior to our evaluation of his lower abdomen, where he had injected enoxaparin sodium subcutaneously for4days. Sixmonths later, similar lesionsappearedonhismedial thighs and upper extremities without prior trauma or injection. The patient reported no fevers, chills, joint pain, or swelling. He admitted to social alcohol use. A punch biopsywas obtained of a nondraining yellow-white nodule on the left upper arm (Figure, C). What is your diagnosis?