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Case Reports

Abstract

A 75-year-old male presented with a circular erythematous macule that exhibited central clearing on his right lower back. The clinical impression was telangiectasia versus an involuting granuloma annulare. Subsequently, a shave biopsy was performed, and a specimen measuring 0.8 x 0.6 cm was submitted. Upon histopathologic evaluation, the epidermis was relatively unremarkable, with superficial dermal telangiectasia, and a moderately dense perivascular and interstitial inflammation consisting of lymphocytes, histiocytes, and rare plasma cells. There were several dilated vascular spaces lined by unremarkable endothelial cells, which were surrounded by concentric, eosinophilic, homogenous deposits. Deeper sections revealed increased vascular proliferation, characterized by a thick eosinophilic vessel wall. PAS stain brightly stained the material surrounding the vessels. CD117 stain demonstrated the presence of occasional mast cells within the dermal infiltrate, without evidence of a mast cell disorder. The crystal violet stain was negative. These findings support a diagnosis of cutaneous collagenous vasculopathy. Although this condition typically affects the bilateral lower extremities with telangiectasias, this case describes a rare presentation of the disease, previously noted as annular lesions with a fading center. However, in our case, the clinical presentation features a solitary lesion on the lower back. Follow-up will help determine whether this continues to be an isolated lesion or if the patient develops multiple lesions over time.