2010 Volume 120 Issue 14 Pages 3103-3108
A 72 year-old Japanese male had asymptomatic erythematous plaques with erosions on both dorsal hands and fingers. Histopathological features included dense dermal neutrophilic infiltration with collagen fibrolysis and absence of vasculitis. Four weeks later, concurrently with ulceration of the lesions on the hands, varied eruptions appeared on the other sites, including erythematous plaques and folliculitis, purpuric papules on the legs, and pustulosis palmoris et plantaris-like eruptions on both palms. Histopathological features of the purpuric papules included vasculitis with neutrophilic and lymphocytic infiltration. All the eruptions improved after 3 weeks of treatment with minocycline and topical steroid, and no scars remained. Based on the clinical and histopathologic findings, our case fits into the category of neutrophilic dermatoses. The various histopathological patterns of neutrophilic infiltration in the epidermis and dermis account for the diverse eruptions. Physicians should be aware that pyoderma gangrenosum-like lesions occurring on the dorsal hands that are similar to lesions of atypical mycobacterium may present as the initial manifestation of a neutrophilic dermatosis.
