A 47-year-old woman presented with a 7-month history of multiple painful erythematous plaques on her lower legs. The lesions appeared as erythematous nodules on the left leg with tenderness and pruritus and rapidly progressed to both legs. Marked lower-leg edema was noted 20 days prior to the visit. She also had an intermittent fever during the past 3 months that did not respond to antibiotic therapy. The patient’s medical history was unremarkable.

Physical examination revealed ill-defined, indurated erythematous-violaceous plaques on the lower extremities with substantial edema (Figure, A and B). Complete blood cell count revealed a normal white blood cell count with moderate anemia (hemoglobin level, 87 g/L; normal range 115-150 g/L). Additional laboratory tests demonstrated an elevated level of serum lactate dehydrogenase (749 U/L; normal range 100-240 U/L) (to convert to μkat/L, multiply by 0.0167). Quantification of Epstein-Barr virus (EBV) DNA in sera showed a high viral load of EBV in peripheral blood (1 800 000 copies/mL, normal range <500 copies/mL). A skin biopsy specimen was obtained from a violaceous plaque (Figure, C).

一名47岁的妇女在小腿上出现了七个月的多处疼痛性红斑性斑块病史。病变表现为左腿红斑结节，伴有压痛和瘙痒，并迅速发展至双腿。访视前20天发现明显的小腿浮肿。在过去的三个月中，她还出现了间歇性发烧，对抗生素治疗没有反应。患者的病史不明显。

体格检查发现下肢硬朗性红斑-紫胶斑块模糊不清，并伴有实质性水肿（图A和B）。全血细胞计数显示正常的白细胞计数，伴有中度贫血（血红蛋白水平为87 g / L；正常范围为115-150 g / L）。其他实验室测试表明，血清乳酸脱氢酶水平升高（749 U / L；正常范围100-240 U / L）（换算为μkat/ L，乘以0.0167）。血清中爱泼斯坦-巴尔病毒（EBV）DNA的定量显示外周血中EBV的病毒载量很高（180万拷贝/ mL，正常范围<500拷贝/ mL）。皮肤活检标本是从一块紫斑中获得的（图C）。