Acta Dermato-Venereologica issue 50:1 98-1CompleteContent | Page 47

159 Crusted Nodules on the Lower Left Arm in a Traveller Returning from South America: A Quiz Ugur USLU, Michael ERDMANN, Stefan SCHLIEP and Michael STICHERLING Department of Dermatology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Ulmenweg 18, DE-91054 Erlangen, Germany. E mail: [email protected] A 64-year-old German man, employed as a university bio- logist, with a past medical history of arterial hypertension and non-Hodgkin’s lymphoma presented with 2 swollen and erythematous boil-like lesions on his left lower arm. He had first noticed the lesions following insect bites while in Ecuador 4 weeks previously. Bacterial infection was suggested and oral ciprofloxacin treatment was started at a local Ecuadorian hospital. However, the skin lesions further increased in size and intermittent serosanguinous effusion was noted, leading to the current presentation after his return to Germany. In addition, intermittent pulsation and “movements” inside the skin lesions were reported. Fever and malaise were absent. Physical examination revealed 2 crusted nodules on the lower left arm (Fig. 1). Blood tests did not show pathological results. Ultrasound examination revealed subcutaneous oval lesions with thin echo-poor halo, and demarcated echo-rich structures with dorsal attenuation surrounded by oedematous connective tissue. What is your diagnosis? See next page for answer. Fig. 1. Clinical findings at the time-point of first presentation. Notable are 2 crusted nodules on the patient’s lower left arm, 1 cm in diameter with a central pore and pronounced surrounding erythema and swelling. QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2018 Acta Dermato-Venereologica. doi: 10.2340/00015555-2804 Acta Derm Venereol 2018; 98: 159–160