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JAMA Clinical Challenge
September 24, 2014

Nasal Erythema and Crusting After a Trip to the Venezuelan Rainforest

Author Affiliations
  • 1Center for Clinical Studies, Houston, Texas
  • 2National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
  • 3Department of Dermatology, University of Texas Health Science Center at Houston
JAMA. 2014;312(12):1250-1251. doi:10.1001/jama.2014.3610

A 32-year-old man with a history of travel to the rainforests of Salto Ángel, Venezuela, presented 6 months after his travel with skin lesions on the nose and neck of 3 months’ duration. He was seen by 2 dermatologists, a family physician, and an otolaryngologist in Venezuela as well as 2 dermatologists, 2 family physicians, a nurse practitioner, and an infectious diseases specialist in the United States. These 10 clinicians collectively prescribed oral amoxicillin, cefadroxil, cephalexin, azithromycin, clindamycin, and cefdinir as well as intramuscular ceftriaxone and topical bacitracin, mupirocin, and polymyxin B. None of these therapies was of benefit.

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