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Golden Lady

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Case Presentation

A 93-year-old woman presented with confluent yellow plaques with an intense golden glow symmetrically on the neck and lateral face ( Figure 1, A and B ) mimicking a golden camouflage. The histopathology showed CD68-positive foamy macrophages in the papillary dermis ( Figure 1, C and D ), leading to the diagnosis of plane xanthoma. Our patient showed mild dyslipidemia (total cholesterol 6.4 mmol/l [<5.0 mmol/l]). Clinical stigmata for familial hyperlipidemia were not present. Due to the distribution pattern, underlying hematological disorders were ruled out.

Figure 1 .

(A, B) Remarkable presentation of plane xanthoma on the neck and lateral face with a golden hue in a 93-year-old woman. (C, D) Histopathology of plane xanthoma with CD68-positive foamy macrophages in the papillary dermis.

Teaching Point

The location of plane xanthomas can serve as a clue to a particular underlying disease. Plane xanthomas in a normolipemic patient with favored distribution on the neck, upper trunk, and flexural folds should prompt a search of underlying hematological disorders such as monoclonal gammopathy or lymphoproliferative disease [ 1 , 2 ] . Plane xanthomas can precede such disorders by several years; therefore, a regular follow-up is recommended.

References

  1. Diffuse normolipemic plane xanthoma associated with monoclonal gammopathy Cohen YK, Elpern DJ. Dermatol Pract Concept.2015;5(4):65-67. CrossRef PubMed
  2. Diffuse plane normolipaemic xanthomatosis as a manifestation of monoclonal gammopathy Morsink LM, Nijhof IS. Br J Haematol.2019;187(4):411. CrossRef PubMed

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