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Off-Center Fold
April 2009

Agminated Papules and Pustules on the Flank—Quiz Case

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Arch Dermatol. 2009;145(4):479-484. doi:10.1001/archdermatol.2009.35-a

A 57-year-old cattle rancher presented with an eruption near his right hip of 4 months' duration. The lesion was slowly enlarging and slightly pruritic. His medical history was unremarkable. He had no constitutional complaints. The patient had worked on his cattle ranch in western Iowa for many years.

Physical examination revealed agminated red papules and pustules on his lower right flank near the hip (Figure 1). The results of the rest of the skin examination were normal. A punch biopsy specimen was obtained from 1 of the pustules. Microscopic examination revealed scattered inflammatory aggregates in the dermis with multiple eosinophils. The microscopic findings were not diagnostic, and a lactophenol cotton blue preparation (Figure 2) and fungal culture (Figure 3) were performed.

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