A patient infected with HIV may develop the nodular form of erythema elevatum diutinum (nEED) with multiple skin lesions on the extremities. These need to be distinguished from other nodular skin lesions seen in these patients.
Clinical findings:
(1) presence of circumscribed dermal nodules, that may range from red to yellowish-brown in color
(2) common sites are juxta-articular, over the buttocks, over extensor surfaces and the Achilles tendon
(3) lesions may be asymptomatic, burning, or painful
Laboratory findings:
(1) often the serum shows a paraproteinemia, typically IgA
(2) cultures of the lesions are negative for micro-organisms
(3) elevated erythrocyte sedimentation rate (ESR)
Skin biopsy findings:
(1) leukocytoclastic vasculitis
(2) nodular accumulation of histiocytes, spindle cells and neutrophils
(3) areas of fibrinoid necrosis
(4) areas of dense fibrosis
Differential diagnosis:
(1) bacillary angiomatosis
(2) Kaposi's sarcoma
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