A 20 year old white man presented to the dermatology clinic for evaluation of draining facial nodules. The patient was a member of the military, and was anticipating imminent deployment to the Middle East. His history was notable for being stationed in southern California several months previously, while in basic training. In addition, his family had recently adopted a stray kitten that had been sleeping in the same bed with the patient.
The patient reported that when the eruption first appeared, 4-6 weeks prior to his presentation in our office, the lesions looked like "ringworm," with circular pink scaly patches. His primary care physician treated him at that time with Lotrisone" (clotrimazole/betamethasone dipropionate) twice daily. Because the lesions worsened, becoming more painful and swollen, with purulent drainage, his physician then treated him with a course of cephalexin, followed by a course of azithromycin, and finally a course of Augmentin", all while continuing his Lotrisone". The patient also reported that two large "boils" on his face were drained by his primary care doctor. The patient reported moderate clinical improvement on Augmentin".
The patient then presented to us for a second opinion. He was concerned this eruption would interfere with his deployment. Upon presentation, the patient appeared as a healthy male in no distress. He was afebrile and vitals were stable. On examination, he was noted to have erythema and inflammation of his lower face and neck, with draining red nodules along his jawline (Figures 1-2). In addition, he had two pink scaly plaques on his abdomen, each with central pustules (Figure 3).
Four punch biopsies were performed, two for tissue culture and two for histopathologic examination. In addition, wound cultures from the pustules on his abdomen were obtained. A PPD was placed to rule out tuberculosis, and was found to be nonreactive. A chest x-ray was within normal limits.
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