Firm brown nodules in an older woman

A 73-year-old African-American woman with a history of polymyositis noted purple papules that evolved into firm brown nodules over the past year. The initial wrist lesion was followed by purple-brown nodules on other areas, including her legs, umbilicus, and most recently her eyelid. Medications included chronic prednisone and IV immunoglobulin (IVIG). She reported no other medical history; in particular, she denied a history of HIV. Biopsy of one nodule revealed a dermal vascular proliferation of spindle cells with intervening RBCs.

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