A man in his 60s was admitted to the hospital for an 8-day history of abdominal pain, bloating, vomiting, diarrhea, subjective fever, weight loss, and fatigue. He also complained of multiple tender red lesions on his bilateral ankles and legs that appeared 2 days prior to admission. Findings from a review of systems were negative for cough, sore throat, history of hepatitis, tuberculosis, sarcoidosis, inflammatory bowel disease, or sulfonamide use.
Physical examination revealed several ill-defined, exquisitely tender erythematous subcutaneous nodules on his bilateral shins, medial feet, ankles, and right lower thigh without overlying ulceration, necrosis, or drainage (Figure, A and B). A punch biopsy was performed, demonstrating pathognomonic histopathologic findings (Figure, C and D).
Gou DE, Turrentine JE, Motaparthi K. Tender Leg Nodules in a Hospitalized Patient. JAMA Dermatol. 2015;151(1):95-96. doi:10.1001/jamadermatol.2014.2727