July/August 2004

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A 39-year-old African-Amefican male who worked as a roofer presented to the emergency department with a 2 week history of fever, chills, nausea, fatigue, and a twenty pound weight loss. A chest x-ray revealed hilar lymphadenopathy and presumptive treatment for pneumonia was begun with oral levofloxacin.

He returned one week later with the additional onset of diffuse lymphadenopathy, decreased visual acuity, a tender effusion of the left wrist, and new skin lesions. He was then referred to ophthalmology and dermatology.

Physical Examination:

Ophthalmologic exam revealed panuveitis with bilateral chorio-retinal masses.

Skin exam revealed multiple skin-color papules and nodules over the face, ranging in size from 3-15 mm (Figs. 1,2). Some of the lesions had central crusting and ulceration (Fig 3). He additionally had a 5 cm firm left submental mass and diffuse lymphadenopathy over the entire body.

Laboratory Studies: HIV: Negative.

Three 4 mm punch biopsies were performed for culture and H&E.


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