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Reikan Focal Cracked



 


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ema ([Fig. 2](#fig2){ref-type="fig"}). Lumbar puncture was performed with cerebrospinal fluid analysis showing protein 106 mg/dL and glucose 86 mg/dL. ![Right-sided retroorbital pain with ocular hyperemia, proptosis, and chemosis.](omcl0201_0004){#fig1} ![Right-sided retroorbital swelling with exophthalmos.](omcl0201_0005){#fig2} Bilateral diffuse nodules of the face, tongue, dorsum of the tongue, palms, and soles were also identified. A muscle biopsy of the right orbicularis oculi was performed. The biopsy was examined by both light and electron microscopy and showed abundant collagen deposition, replacing muscle fibers, and marked hypertrophy of the reticular dermis with thick collagen bundles and hypertrophic fibroblasts. The main findings of the biopsy were therefore the presence of extracellular matrix material (collagen) and fibroblasts without signs of inflammation or necrosis. The patient was hospitalized and treated with an intravenous prednisolone course. She is currently receiving oral corticosteroids. After 2 months of therapy, her previous findings disappeared. The patient was neurologically asymptomatic. DISCUSSION {#s2} ========== This patient had several novel dermatologic findings associated with generalized morphea, which was associated with neurologic symptoms. While morphea is a disease with the presence of idiopathic, nonpitting edema, it is an extremely rare finding to observe in cases of MM. There are no signs of active inflammation and therefore no amelioration of edema in this patient. Further, the possibility of the disease being secondary to hematologic malignancy was excluded. Morphology of the lesions shows that there is a gradual transition from healthy skin to fibrosis. The lesions of morphea can be subdivided into three categories, which include localized, generalized, and subcutaneous forms. Morphea of the face is one of the subcutaneous forms. The disease has a female preponderance, affects mainly adults, and usually presents with a skin lesion of a confined area, with typical circular or oval-shaped subcutaneous lesions. It is a chronic disease and frequently has a long latent period. The onset

 

 

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Reikan Focal Cracked

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