May 2002


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History:

This 49-year-old female presented with a 10-month history of firm nodules that became pruritic, then painful after scratching. They subseqyently resolved spontaneously into hyperpigmented patches. The initial lesion was on her back and on presentation to our clinic, she had a nodule on her left flank which had been present for 1-2 weeks and several healing lesions on her left arm . The patient denied any recent travel; her past medical history and a review of systems were unremarkable. Her only medication was occasional NSAID use for pain.

 

Physical Exam:

She had a 1.5 x 1.2 cm firm, indurated, hyperpigmented, scaly nodule on her left flank which was tender (Fig 1). She also had several round hyperpigmented macules and tumors on her left upper arm (Fig 2). The remainder of her exam was normal including no cervical, supraclavicular, axillary or inguinal lymphadenopathy.

 

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