Persistent Asymptomatic Nodules on the Legs

REPORT OF A CASE A 53-year-old woman presented with five, nontender, asymptomatic, brownish nodules (10 to 30 mm) on the anterior aspect of her legs. Four were on the left pretibial area and one was on the right (Fig 1). These nodules were gradual in onset and had been enlarging for several weeks. She had rheumatic fever when she was 18 years old. Type II diabetes mellitus and essential hypertension were diagnosed 1 year before. She also reported an acute episode of tachycardia, diffuse sweating, asthenia, and heat intolerance 9 months before, at which time a diagnosis of Graves-Basedow disease was established. At the time of presentation, the patient was receiving propranolol, carbimazole, and sulfonylurea. In addition to the cutaneous lesions, the patient presented with a diffuse, palpable goiter; her blood pressure was 130/70 mm Hg and her pulse rate was 120 beats per minute. The chest roentgenogram revealed