Quiz page answers January 2005   American Journal of Kidney Diseases  Volume 45, Issue 1, Pages e1-e2 (January 2005) DOI: 10.1053/j.ajkd.2004.07.024 Copyright © 2004 Terms and Conditions

Figure 35A What is your differential diagnosis for the subcutaneous nodules? The clinical differential diagnosis includes lipomas, hematomas, foreign-body reaction, lymphoproliferative disorders, infectious disorders, subcutaneous calcifications with or without secondary hyperparathyroidism or other types of renal osteodystrophy, tuberculosis, sarcoidosis, silicosis, leprosy, tertiary syphilis, beryllium disease, and lupus erythematosus. His physical examination findings were remarkable for no fever, no peripheral enlarged lymph nodes, and the absence of enlargement of the liver or spleen. Chest x-ray results were normal, with no sign of tuberculosis or sarcoidosis. His biological parameters showed anemia well controlled by exogenous erythropoietin therapy: hemoglobin level, 11.5 g/dL (115 g/L); and white blood cell count, 4,000/μL with 65% neutrophils, 2% eosinophils, 0.2% basophils, 27% lymphocytes, and 5.8% monocytes. He had moderate thrombopenia, with a platelet count between 40,000 and 80,000/μL. The patient’s serum parathyroid hormone level was 150 pg/mL (150 ng/L), serum-corrected total calcium level was 9.8 mg/dL (2.44 mmol/L), phosphorous levels were in the range of 6.5 to 8.5 mg/dL (2.10 to 2.75 mmol/L), and bone-specific alkaline phosphatase level was 7.0 ng/mL. Serum vitamin D, calcitriol, and angiotensin-converting enzyme levels were normal. Human immunodeficiency virus serological test results were negative. He did not have cardiovascular calcifications, and standard radiographs of the upper- and lower-extremity lesions did not show soft-tissue calcification. American Journal of Kidney Diseases 2005 45, e1-e2DOI: (10.1053/j.ajkd.2004.07.024) Copyright © 2004 Terms and Conditions

Figure 35B What do you observe on this skin biopsy specimen? (Hematoxylin and eosin stain; original magnification ×100.) What is your diagnosis? This image shows the presence of multiple, sharply delineated, non-necrotizing granulomas with epithelioid-like multinucleated giant cells and accompanying interstitial inflammation and lymphoplasmacytic infiltrate. No pathogenic agent was seen on Ziehl staining. American Journal of Kidney Diseases 2005 45, e1-e2DOI: (10.1053/j.ajkd.2004.07.024) Copyright © 2004 Terms and Conditions

Figure 35C The multinucleated giant cell typical of sarcoidosis is shown under high magnification. (Hematoxylin and eosin stain; original magnification ×400.) American Journal of Kidney Diseases 2005 45, e1-e2DOI: (10.1053/j.ajkd.2004.07.024) Copyright © 2004 Terms and Conditions