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A skin biopsy specimen from the right forearm revealed superficial ulceration, with an intense inflammatory infiltrate with mycetomalike granules clustered in the middle to superficial dermis. These hyaline-appearing clusters demonstrated the Splendore-Hoeppli phenomenon. Gram staining confirmed gram-positive cocci in a cluster resembling the "grain" seen in mycetoma (Figure 4).
Sudden Onset of Multiple Painful Erythematous Papules and Pustules—Diagnosis. Arch Dermatol. 2003;139(1):93–98. doi:10.1001/archderm.139.1.93-a
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