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REPORT OF A CASE
A 34-year-old woman presented with a four-month history of facial lesions. She had been well until four months prior to presentation, when she developed what was thought to be impetigo. The eruption spread and she developed a perianal lesion two months prior to presentation. A biopsy specimen of this lesion was obtained by a general surgeon and interpreted by a general pathologist as granulation tissue. The result of a VDRL test done at this time was positive, with a titer of 1:64.At the time of presentation, physical examination revealed soft encrusted granulomatous nodules scattered over the face, with one lesion on the scalp (Fig 1). She had tender cervical lymphadenopathy but was afebrile. The rest of her skin was normal.Laboratory tests included bacterial culture of the lesions, which yielded light growth of Staphylococcus aureus resistant to penicillin. Result of a VDRL was positive, with