Q177) A 55-year-old white woman is seen in your office for a 6-month history of slowly enlarging lesions on both lower extremities. She is otherwise healthy. The lesions are painless. She denies any trauma to these areas. Her past medical history is significant for diabetes mellitus diagnosed 2 years ago and rheumatoid arthritis. Her medications include Metformin, Enalapril and Methotrexate. On skin examination, she has 2 cm yellow, smooth, firm centrally depressed plaques involving the thighs and knees. Image is shown below
The most likely underlying etiology :
A) Drug-induced
B) Rheumatoid arthritis
C) Diabetes Mellitus
D) Malignancy
E) Sarcoidosis
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i think it s a methotrexate induced flare ups !
A erythema nodoso indused by sulfonylurea
C: necrobiosis lipoidica associated with DM.