Zosteriform erythematous rash

Abstract

A 70-years-old male presented with unilateral rash below the right axilla of one-month duration. The patient gave history of cough with shortness of breath for the last two years and pain in the right axilla radiating to the right shoulder for five months. General examination revealed mild pallor, grade 1 clubbing and multiple hard, fixed, non-tender right cervical and supra-clavicular lymph nodes. On cutaneous examination, the lesions were in the form of multiple pseudo vesicular and papulonodular lesions studded over an erythematous, hard, indurated plaque present in a dermatomal fashion along T2 and T3 dermatome below the right axilla (Fig. 1). Contrast-enhanced computed tomography of the lungs showed a heterogeneously enhancing mass of size 5.3 × 3.8 × 3.3 cm, in the right upper and middle lobe, with multiple areas of necrosis and surrounding consolidation. Histopathology from the skin revealed infiltrating tumour cells arranged in nests in the dermis. The tumour cells were oval to polygonal with an enlarged round to mildly irregular nuclei, fine chromatin, prominent nucleoli and abundant clear to eosinophilic cytoplasm. The tumour cells were strongly immunopositive for TTF-1 and negative for p40 and S100.