Chronic Unilateral Eruption of Painful, Erythematous Papules and Nodules

A72-year-oldwhitewoman of German heritage presentedwith a 30-yearhistoryof several painful lesionson the left sideofherbody. Clinical examination revealednumerous tender, erythematouspapules and nodules over her left chest, flank, and lower extremity (Figure 1). The patient’s medical history was significant for hyperlipidemia, multiple uterine leiomyomas status after hysterectomy in 1972, and severe coronary artery disease status after coronary artery bypass grafting in 2004. The patient emigrated from GermanyshortlyafterWorldWar II; familialmedicalhistorywasnotavailable. Her medications were aspirin, warfarin, duloxetine, pregabalin, and atorvastatin. A shave biopsy was performed from a characteristic papule on the left lower extremity. Routine hematoxylin-eosin–stained sections are shown in Figure 2 and Figure 3. What is your diagnosis?