case_images: PMC9827444_01
case_images: a, b Flesh to pink colored papules and nodules with scale on the dorsum of the fingers with involvement of the nail folds.
case_images: cde-2023-0015-0001-528254_f1.jpg
case_images: PMC9827444_01_cde-2023-0015-0001-528254_f1.jpg
case_images: F1
case_images: Physical exam revealed multiple fleshes to pink colored papules with a central puncta-like quality, both discreet and coalesced, on the extensor surface of the digits of the right and left hand with distorted 4th and 5th DIP joints (Fig. 1).
case_images: Plain film of right hand with erosive changes in the fourth and fifth DIP joints.
case_images: cde-2023-0015-0001-528254_f2.jpg
case_images: PMC9827444_01_cde-2023-0015-0001-528254_f2.jpg
case_images: F2
case_images: Review of plain films of the hands (Fig. 2) revealed erosive changes with soft tissue swelling to several DIP and proximal interphalangeal joints bilaterally.
case_images: a, b H&E stained section of biopsy demonstrating histiocytes and Touton-type multinucleated giant cells with abundant eosinophilic cytoplasm and a "ground glass" appearance. x100 and x400 magnification.
case_images: cde-2023-0015-0001-528254_f3.jpg
case_images: PMC9827444_01_cde-2023-0015-0001-528254_f3.jpg
case_images: F3
case_images: The cytoplasm of the cells had an eosinophilic "ground glass" appearance, consistent with changes of reticulohistiocytosis (Fig. 3). The biopsy was initially interpreted as a xanthogranuloma, but upon discussion of the clinical and radiographic features with the dermatopathologist, the formal diagnosis of MRH was made.