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June 1992

Persistent Nodule on the Toe Following Trauma

Author Affiliations

The Pennsylvania State University College of Medicine, The Milton S. Hershey Medical Center, Hershey

Arch Dermatol. 1992;128(6):851-852. doi:10.1001/archderm.1992.01680160135023

REPORT OF A CASE  A 22-year-old man presented with a 3-year history of a solitary red nodule on the dorsal aspect of his left great toe. The nodule arose shortly after the patient injured himself on a nail in his attic. The nodule initially grew rapidly, but then remained relatively unchanged for over 2 years. It was slightly tender and occasionally bled when traumatized. One year before he presented to us, he underwent treatment with an injection of a corticosteroid, which initially reduced the size of the lesion. However, the lesion quickly regrew.Examination of the patient's left great toe revealed a 1.8×1.2-cm dark red, slightly crusted and friable nodule containing a few small sinus tracts (Fig 1). A skin punch biopsy specimen revealed noncaseating dermal granulomas (Fig 2) and was negative for organisms with acid-fast bacilli and fungal stains. Tissue cultures for bacteria, fungi, and mycobacteria were also negative.

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