Papules on the lower limbs of a woman with cervical lymphadenopathy. Lichen scrofulosorum.

REPORT OF A CASE A 77-year-old woman was admitted to the Institute of Medical Pathology in Genoa, Italy, with fever, fatigue, weight loss, and a bilateral cervical lymphadenopathy of two months' duration. She also exhibited an asymptomatic cutaneous eruption on her lower limbs that had begun at the same time as the general symptoms. Dermatologic examination revealed red-brown, slightly scaling follicular and perifollicular papules that coalesced in irregular plaques on her lower extremities, particularly on the legs and feet (Figs 1 and 2), and were more discrete on the trunk. There was a bilateral cervical lymphadenopathy; the lymph nodes were adherent to the skin and deeper tissues and tended to fluctuate. Laboratory findings were as follows: erythrocyte sedimentation rate, 116 mm/h; hemoglobin, 91 g/L (9.1 g/dL); red blood cell count, 3.2 × 10 12 /L (3.2/ mm 3 ); and white blood cell count, 4.3 × 10 9 /L (4320/ mm