Late-stage nodular erythema elevatum diutinum mimicking sclerotic fibroma

Abstract

Erythema elevatum diutinum (EED) is a rare, cutaneous vasculitis of uncertain origins. EED can present clinically as chronic bilateral, symmetrical, periarticular papules, plaques, and nodules. We report here an unusual case of EED presenting as multiple, densely fibrosing nodules on the feet of a 60 year-old HIV positive woman. The initial evaluation of the patient was complicated by the strong histologic resemblance of multiple lesions to sclerotic fibroma (SF), a cutaneous manifestation of Cowden disease. Our case highlights the important features that distinguish these two pathologic entities.