Inflamed Bipedal Nodules with a Distant Occult Cause.

Answer: E A 76-year-old Chinese male presented with red and tender rashes associated with progressive swelling over both lower limbs for 2 weeks. Concurrently, he had fever and non-bloody diarrhoea. There was no abdominal pain, joint pain, loss of appetite or weight. He was otherwise systemically well. His past medical history was signifi cant for diabetes mellitus, hypertension and hyperlipidaemia. Long-term medications included glipizide, metformin, enalapril, nifedipine and simvastatin. There were no new medications commenced 6 months prior to the onset of his rashes. On examination, there were warm tender erythematous nodules over both anterior shins, posterior aspect of calves and thighs (Figs. 1A and 1B). Pitting oedema up to the level of the knees was present. Cardiovascular, respiratory and abdominal examination was unremarkable. Histological examination of a skin biopsy from the left thigh showed fat necrosis with “ghost-like” cells, characterised by anucleated adipocytes with a partially digested cell membrane (Fig. 2). This was also accompanied by basophilic deposits of saponifi ed fat (Fig. 3). What is the diagnosis for these cutaneous lesions? A. Erythema nodosum B. Erythema induratum C. Lupus profundus D. Subcutaneous panniculitis-like T cell lymphoma (SPTCL) E. Pancreatic panniculitis