Cutaneous mucinosis in mixed connective tissue disease
CASE 2: A 42-year-old male, diagnosed with MCTD (Kasukawa's classification\ncriteria) for eight years. He had Raynaud's phenomenon, hand swelling, pleurisy,\nlymphadenopathy, arthritis, myopathy and anti-RNP antibodies titers 1/6400\n(haemaglutination. The patient remained clinically stable for more than seven months\nwith prednisone 15mg/day and azathioprine 2.0 mg/ kg / day when he presented\nerythematous-violaceous indurated mildly pruritic and painless lesions in the face,\ntrunk and upper limbs (). As there were no\nother signs of MCTD disease activity, the dose of prednisone was reduced to 7.5 mg/ day\nand azathioprine was discontinued. Histopathological analysis of papules of the trunk\nshowed epidermal parakeratosis and hyperorthokeratosis. Perivascular, interstitial and\nperiadnexal lymphocytic inflammatory infiltrate appeared in the dermis (predominantly\nthe former). The alcian-blue and the PAS staining revealed interstitial\nmucinosis in the reticular dermis. Chloroquine diphosphate was introduced (250 mg/ day)\nand the prednisone dose was increased to 20 mg/ day, with improvement of the\nlesions.