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August 2003

Rash With Regional Lymphadenopathy—Quiz Case

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Arch Dermatol. 2003;139(8):1075-1080. doi:10.1001/archderm.139.8.1075-a

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).

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