This 48 year old woman tells you these lesions began as “acne bumps” on her legs. A biopsy reveals ulceration and a mixed inflammatory infiltrate, including neutrophils. A tissue culture for infectious organisms is negative. What is the most likely underlying systemic condition in this patient?

A. Celiac disease

B. Ovarian cancer

C. Chronic pancreatitis

D. IgA monoclonal gammopathy

E. Castleman’s disease

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