Fig. 1

Signs and symptoms at presentation of a 12-year-old girl with systemic lupus erythematosus, Castleman disease, and paraneoplastic pemphigus. (A) Old brown pigmentation over the whole body. (B) Right neck mass. (C) Multiple ulcers and erosions on the mucous membranes of tongue tip and lips, and red scabs on the lips. (D) Finger flexion and deformity, and ulcerations and scabs of the skin on the palm. (E) Bilateral plantar areas