A 61-year-old man had long been plagued by symptoms of atopy and connective tissue disease when he presented with an 18-month history of soft, compressible nodules on both shins. His past history included atopic eczema since adolescence, asthma, hay fever, and hypertension. Two years earlier he experienced spontaneous venous thrombosis in the right arm. He also had elements of CREST syndrome, a constellation that includes calcinosis, Raynaud’s syndrome, esophageal dysmotility, sclerodactyly, and telangiectasias. Our patient had a 10-year history of Raynaud’s phenomenon, facial telangiectasias, reduced oral aperture, and esophageal reflux.
Assessment
General examination revealed pitting edema of the face, hands, and lower legs, and bilateral cauliflower ear deformity (Figure 1). This had been present for 10 years, without prior trauma and with no clinical features of chondritis. The patient did not have macroglossia.
What’s the diagnosis?
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— Diona L. Damian, MBBS, PhD, Jim V. Bertouch, MBBS, MD
This article originally appeared in theOctober 2010issue ofThe American Journal of Medicine.
