Multiple Vegetating Granulomatous Nodules in a 94-year-old Man

CASE REPORT A 94-year-old male patient presented with multiple vegetating and granulomatous nodules on the right groin and gluteal region in the recent one year (Fig. 1A). He was robust before without any other systemic diseases except oral erosion developed one week before he visited our clinic. Tentative diagnosis included cutaneous fungal infection, cutaneous T cell lymphoma, and vegetating blistering disease. Bacterial and fungal culture showed no growth of microorganism. An incisional biopsy was performed in the gluteal region and histopathology showed epidermal hyperplasia, and intraepidermal eosinophilic absecsses (Fig. 2). Direct immunofluorescence(DIF) studies of the lesion revealed intraepidermal IgG and C3 deposition (Fig. 3). Indirect immunofluorescence revealed circulating antiepithelial cell surface IgG. The patient responded well to topical occlusive clobetasol treatment and those lesions regressed a lot after one week (Fig. 1B). Resident Forum