A healthy 43 yo male tile worker came to office today saying that this lesion started as a pimple 4-5 m ago. He was born in Mexico Guajuatenejo which is urban. He moved to USA over ten years ago.The color is a little more vivid than is represented in this photo.
His review of systems is negative and he has not applied any medicine to this lesion. It looks like a granuloma eaten away, but we have no path. He has a small red streak running east west one inch above the nipple and on the medial side. It resembles the streak of visceral cutaneous migrans.See photo above.
His CBC is normal and his chest xray has no acute disease. We applied a PPD because both hilar areas appeared large and his parenchymal markings are too prominent.
A few weeks later he developed a group of four lesions on his R flank. They appear crusted over without any associated redness, drainage, or warmth. They measure 1-2 cm and the group is in an area of 5x5 cm. We will biopsy if he returns and if he can afford the path($400).
I am stumped. Your comments are appreciated.
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