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Indurated plaques and nodules on the buttocks of a young healthy female.

46 DIAGNOSTIC DILEMMAS IN DERMATOLOGY Case Report A 30-year-old Dominican woman with no prior medical history presented to the outpatient dermatology clinic with complaints of severe pain, swelling, and “hardness” of both buttocks, which had steadily worsened over the past year. She reported no prior history of any skin problems. She denied any recent travel or trauma to the area, but reluctantly admitted to prior injections of an unknown substance into the buttock for cosmetic enhancement. The patient described an initial cosmetic improvement without complications, but steadily developed an increasing number of painful “bumps” that made it difficult to function normally, impeding her ability to comfortably sit or stand. Systemic symptoms, such as fever, joint pain, and chills were intermittently felt. Physical examination revealed edematous and diffuse woody indurated plaques and nodules of the bilateral buttocks that were tender to palpation (Figure 1). Inguinal lymphadenopathy was present, but no joint swelling was appreciated. A punch biopsy of the skin was sent for microscopic analysis (Figures 2 and 3). Diagnosis Silicone granuloma