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Multiple painful nodules - What is the diagnosis?

  • Author(s): Avhad, Ganesh
  • Dandale, Ameet
  • Ghate, Smita
  • Dhurat, Rachita
  • et al.
Main Content

Unknown: Multiple painful nodules - What is the diagnosis?
Ganesh Avhad MBBS MD, Ameet Dandale, Smita Ghate, Rachita Dhurat
Dermatology Online Journal 17 (12): 9

LTMMC and GH, Mumbai, Maharashtra, India

A 55-year-old hypertensive, chronic alcoholic and diabetic male, presented with a three-year history of multiple painful skin-colored nodules with discharging sinuses on the forearms, elbows, feet, posterior thighs, and popliteal fossae (Figure 1).


Figure 1 Figure 2

Cutaneous examination revealed tender skin-colored to erythematous, firm nodules on forearm, elbows, feet, posterior thighs, and popliteal fossae. The lesions over feet showed central softening with a few sinuses discharging chalky white material. Systemic examination was normal. X rays of elbows, wrists, knees, ankles, and bilateral great toes showed joint space reduction associated with bony destruction. Polarizing microscopy of fine needle aspiration cytology from a nodule is shown in Figure 2 and histopathology of a nodule is shown in Figures 3 and 4.


Figure 3 Figure 4

What Is Your Diagnosis?



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