Abstract
A 45-year-old man was referred to us for the examination of multiple painful erythematous nodules of approximately one month’s duration on his extremities and buttocks. Physical examination revealed the characteristic appearance of thrombophlebitis migrans with erythematous nodules and post-inflammatory pigmentation in a linear arrangement on his extremities and trunk. The erythrocyte sedimentation rate and the serum level of c-reactive protein both markedly increased. An electrocardiogram showed frequent ventricular premature contractions. A biopsy specimen taken from a nodule on the forearm showed the complete luminal occulusion of medium-sized vessels with thrombi in the deep dermis, the infiltration of neutrophils and eosinophils in the vessel walls, and a slight deposition of fibrinoid material as well. Cutaneous polyarteritis nodosa was excluded due to a lack of a distinct internal elastic membrane, complete occlusion with thrombi of the blood vessels, and inconspicuous fibrinoid materials. The administration of oral corticosteroids, anticoagulants and immunosuppressants resulted in gradual improvement of the skin lesions.
