A 58-year-old female patient presented with asymptomatic nodules that had been on her lower legs for 10 years. The nodules appeared spontaneously without any discernible cause and progressively increased in number. The patient had a two-year history of primary Sjögren’s syndrome (SjS). Physical examination revealed on both of her lower legs the presence of multiple yellow-red nodules of varying sizes characterized by a firm texture, clear borders, and a waxy surface appearance (Fig. 1 a). A biopsy further revealed hyperkeratosis, acanthosis, and massive deposits of eosinophilic amorphous material in the dermis and around blood vessels (Fig.
