case_images: PMC3995393_01
case_images: Photograph of the skin lesion showing an indurated plaque measuring 13 x 65 mm in size, with ulcers arranged linearly, together with yellowish-white substance. The ulcers were surrounded by reddish skin on the left forearm.
case_images: cde-0006-0085-g01.jpg
case_images: PMC3995393_01_cde-0006-0085-g01.jpg
case_images: F1
case_images: Physical examination showed an indurated plaque of 13 x 65 mm with linearly distributed ulcers covered by yellowish-white material, and the entire lesion was surrounded by reddish skin (fig. 1).
case_images: a HE-stained biopsy section showing deposition of a basophilic amorphous material in the upper and middle dermis. Note also the granulomatous infiltration surrounding the amorphous substance and accumulation of collagen. b A high-power view showing histiocytic infiltrates intermingled with lymphocytes and giant cells between collagen fibers. c von Kossa staining confirmed that the amorphous substance was calcium deposition. Magnification: a x40; b x200; c x40.
case_images: cde-0006-0085-g02.jpg
case_images: PMC3995393_01_cde-0006-0085-g02.jpg
case_images: F2
case_images: The histopathological findings were similar in the two specimens and included deposition of basophilic amorphous substance in the upper and middle dermis (fig. 2a), but not in the subcutis. Histiocytic infiltrates intermingled with lymphocytes and giant cells among the collagen fibers (fig. 2b). The amorphous substance stained black with von Kossa staining (fig. 2c).
case_images: Photograph of the lesion taken 2 months after treatment. Note the scar formation.
case_images: cde-0006-0085-g03.jpg
case_images: PMC3995393_01_cde-0006-0085-g03.jpg
case_images: F3
case_images: The whitish chalky substance disappeared gradually within 1 month, together with healing of the ulcers within 2 months, with scar formation (fig. 3).