Erythematous lump on the abdomen

A 76-year-old woman presented with a 3-month history of a lesion on her abdomen.

The lesion had gradually increased its size and the patient reported local pain. No systemic signs or symptoms were observed. Examination revealed an erythematous lesion, 3 cm in diameter, with diffuse margins, lightly adhering to the deep underlying tissue, on the left abdominal flank. A firm and indurated nodule was palpable. On lateral compression the lesion became depressed in the centre. Chest X-ray and blood tests, including full blood count, erythrocyte sedimentation rate and liver enzymes, were normal.

Differential diagnosis for a painful erythematous nodule included panniculitis, fungal and bacterial infections, vascular and malignant lesions. Suspecting a cutaneous metastasis of a digestive neoplasm or an advanced digestive neoplasia, we performed an abdominal X-ray before performing computed tomography, which revealed a radiopaque foreign body. This foreign body was identified as a sewing needle.

The nodule and the needle were removed under local anaesthesia, and histology of the nodule showed an intense perilesional granulomatous reaction, compatible with a foreign body reaction.

CITATION  Br J Dermatol. 2004 Apr;150(4):769