A 37-year-old white man presented with a 3-month history of a pruritic rash involving the upper extremities, thighs, scrotum, and buttocks. He had associated arthralgias and a low-grade fever. He was concerned that his symptoms were related to his pig-farming occupation. On physical examination, pink papules and plaques measuring 4 to 10 mm in diameter were noted predominantly over the thighs, forearms (Figure 1), dorsal aspects of the hands, and face. Rare similar papules also were present over the buttocks, scrotum, lower aspects of the legs, and dorsal aspects of the feet. There was no evidence of lymphadenopathy or arthritis. A skin biopsy specimen was obtained (Figure 2 and Figure 3). Because of a suspicion that the findings in this case represented a systemic process, chest radiography was performed (Figure 4). A chest x-ray film revealed masses and nodules in the lower part of the left lung (small arrows) and a subpleural nodule in the lower part of the right lung, medially adjacent to the diaphragm. There was also adenopathy in the lower right side of the mediastinum, behind the heart (large arrow). Computed tomography of the chest confirmed these findings. The histopathologic findings of a transbronchial biopsy were similar to those of the skin biopsy.
Byrd DR, Vandersteen DP, Beech EJ, Davis MDP. A Pig Farmer With Pruritic Pink Papules and Plaques—Quiz Case. Arch Dermatol. 2003;139(6):803-808. doi:10.1001/archderm.139.6.803-a