Resident Rounds Part III: Case Report: A Papulo-Nodular Eruption With Systemic Signs and Symptoms

April 2015 | Volume 14 | Issue 4 | Features | 422 | Copyright © April 2015

Lindsey E. Richards BS, Mary E. Horner MD, and Alan Menter MD

Department of Dermatology, Baylor University Medical Center, Dallas, TX Texas Dermatological Associates, Dallas, TX

Abstract
This is a typical presentation of erythema nodosum leprosum in a patient with lepromatous leprosy who recently migrated from Micronesia. The clinical presentation, pathology findings, pathogenesis, and therapeutic options are reviewed here.

CASE REPORT

A 27-year-old male who had migrated from Micronesia 12 days previously presented with a 2-day history of rash, fever, weight loss (25 lbs), night sweats, and acute pain in his left leg that prevented ambulation. Upon examination, he was observed to have scattered discrete 5 mm to 15 mm erythematous papules and nodules on the trunk and extremities (Figure 1), skin-colored nodules on his earlobes bilaterally, and a 30 mm erythematous and tender left inguinal lymph node. He had no mucus membrane or neurologic abnormalities. Laboratory abnormalities included a leukocytosis and elevated serum lactate.

DISCUSSION