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May 2010

Multiple Pruritic Erythematous Papules on the Trunk After a Trip to Thailand—Quiz Case

Author Affiliations
 

MARY S.STONEMDSOONBAHRAMIMDCARRIE ANN R.CUSACKMDSENAIT W.DYSONMDMOLLY A.HINSHAWMDVINCENTLIUMD

Arch Dermatol. 2010;146(5):557-562. doi:10.1001/archdermatol.2010.78-a

A 30-year-old white man was referred for an itchy red eruption of the trunk that was noted after a 3-week vacation in Thailand. It was refractory to a 2-week course of potent topical corticosteroid treatment. He complained of a sensation of “bugs crawling.” Alcohol consumption, sexual contact with condom use, and lying on the beach for extended periods of time were reported. Multiple, randomly scattered, highly pruritic, erythematous, blanching papuloplaques without scaling, vesiculation, or purpuric changes were noted on the chest and abdomen (Figure 1). The lesions had not migrated, nor were they linearly arranged. Laboratory examinations revealed only elevated alanine aminotransferase levels (57 U/L; normal range, 0-36 U/L) (to convert alanine aminotransferase to microkatals per liter, multiply by 0.0167). Chest radiography and abdominal ultrasonography findings were unremarkable. A skin biopsy of a representative lesion was performed, and the specimen underwent histologic examination with hematoxylin-eosin (Figure 2). The tentative diagnosis was papular urticaria.

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