Abrupt Onset of Ulcerative Papules and Nodules on the Face and Genitals.

Abstract

Amaninhis60swithamedicalhistoryofhypertension,cerebrovascularaccident,coloncancer, and remote cocaine use presentedwith numerous pruritic crusted papules and nodules on the face and genitals. The eruption presented abruptly over a 2-week course, and the patient attributed it to contact with plants while working in his yard. He denied having similar lesions in thepast.Hehadusedover-the-counter topical antibioticandantihistaminecreams, which alleviated the pruritus. He denied recent sexual intercourse, penile discharge, fevers, chills, nausea, or vomiting. Physical examination of the bilateral cheeks, glabella, dorsal nose, and chin revealed multiple skin-colored papules, nodules, and vegetative plaques ranging in size from 4 to 6mm in diameter, with central umbilication, erosions, and overlying yellow crust (Figure, A). There were similar lesions on the scrotum and inner thighs, with sparing of the penis (Figure, B). There was also a 1-cm ulceration on the left lower lip. The palms and soles were spared. There was no lymphadenopathy noted. One 4-mm punch biopsy specimen was obtained from a nodule on the left medial cheek, bisectioned, and sent for both hematoxylin–eosin staining and tissue cultures for bacteria, fungi, and atypical mycobacteria (Figure, C and D). Patient photograph A Patient photograph B