case_images: PMC10404591_01
case_images: Clinical presentations at admission. (A and B) Hypertrophic dark red plaques were seen in the head-face-neck area and torso, which had partially merged together.
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case_images: Dermatological examination showed hypertrophic dark red plaques with clear margins and irregular shapes in his head-face-neck area and torso, some of which had merged together (Figure 1A and B).
case_images: (A) (x100) and (B) (x200): Obvious perivascular infiltration of clumps of lymphocytes, plasma cells, and eosinophils was observed from the superficial to deep dermis; (C) (x100), (D) (x100), (E) (x100) and (F) (x100): IHC examinations of CD138, Ki-67, IgG, and IgG4 respectively, with IgG4/IgG exceeding 40%.
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case_images: Besides, obvious perivascular infiltration of clumps of lymphocytes, plasma cells, and eosinophils was also observed from the superficial to deep dermis, which involved the lipid membranes, together with mild mucin deposition in collagen spaces (Figure 2A and B). Immunohistochemical (IHC) examination was focally positive for CD138 and scatteredly positive for Ki-67, with IgG4/IgG exceeding 40% (Figure 2C-F).
case_images: (A) Multiple lymph nodes and several enlarged ones were found near the bilateral neck (IIA), bilateral armpits, and iliac vessels of bilateral pelvic wall, with enhanced FDG metabolism; (B) Soft tissue density occupancy in the intermuscular spaces of left retrobulbar muscle cone was observed together with improved FDG metabolism, which was consistent with inflammatory pseudotumor changes within the eye frame in combination with his medical history.
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case_images: Multiple lymph nodes and several enlarged ones were found near the bilateral neck (IIA), bilateral armpits, and iliac vessels of bilateral pelvic wall, with enhanced FDG metabolism (Figure 3A). In combination with his medical history, these manifestations were consistent with inflammatory pseudotumor changes within the eye frame (Figure 3B).
case_images: Lesion manifestations after 3 months of treatment. (A and B) After 6 days of treatment, the skin lesions improved and partially resolved, with mild lesions remaining and post-inflammatory hyperpigmentation.
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case_images: After two weeks of treatment, his pruritus was significantly relieved and skin lesions also resolved (Figure 4A and B).