A 32-year-old man presented with a 6-week history of 3 pruritic skin lesions on his lower back area and thigh. The lesions were temporally related to a vacation that he had taken in Costa Rica. He did not recall having been bitten by an insect while he was traveling. A review of systems revealed no abnormalities. The patient's medical history included asthma and seasonal allergies.
Initial examination revealed three 1-cm firm nodules with central erosion surrounded by a localized area of eczematous dermatitis. There were 2 lesions on the left lower back area and 1 on the posterior aspect of the upper part of the thigh. After intralesional steroid injection, the nodules regressed, and diffuse erythema, shiny papules, and weeping erosions developed 1 month later (Figure 1). The physical examination also demonstrated a nontender, multinodular cord on the left chest wall and flank, a palpable left inguinal node, and edema of the left lower extremity. Biopsy specimens were obtained for histologic examination and culture (Figure 2).
Bradley VR, Liu V, Haynes HA. Rash With Regional Lymphadenopathy—Quiz Case. Arch Dermatol. 2003;139(8):1075-1080. doi:10.1001/archderm.139.8.1075-a