case_images: PMC11129575_01
case_images: Diffuse red raised papule with urticarial-like morphology on lower abdomen/pubic (left) and right lateral thigh region (right).
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case_images: We present the case of a 57-year-old female with a past medical history of osteoarthritis, right vestibular schwannoma status post stereotactic radiotherapy, vulva Bartholin's gland carcinoma, and hypothyroidism who initially presented to primary care with a complaint of "hive-like" skin rash in the lower abdominal, pubic, and medial thigh areas that waxed and waned for about 6 months (Figure 1).
case_images: Histology of right lower abdomen skin punch biopsy showing predominantly perivascular lymphocytic and eosinophilic inflammation with focal perivascular and interstitial neutrophils on background of ectatic small vessels, and mild acanthosis with focal vacuolar interface degeneration more consistent with an urticarial reaction.
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case_images: The first biopsy showed urticarial tissue reaction with focal leukocytoclastic changes and negative direct immunofluorescence (Figure 2).
case_images: Small areas of cystic lesions scattered across both lungs (yellow arrow).
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case_images: Chest and abdomen were conducted. CT chest showed small lung cysts, calcified granulomas and noncalcified pulmonary micronodules (Figure 3).
case_images: Mildly enhanced left kidney lesion with multiple bilateral renal cysts and some hepatic cysts.
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case_images: There were several additional renal and hepatic cysts with no concerning features (Figure 4).