Painful Eruption in a Mountain Biker

Jasna Ikanovic, MD and Animita Saha, MD

December 20,  2017

A healthy 35-year-old male presented to clinic with history of a painful rash. He endorsed approximately 7 days of painful nodules on left side of his neck and ear, later involving his left arm and leg. These lesions first appeared 2 days after a mountain biking trip in North Carolina, during which he suffered a fall. The physical exam was unremarkable, with exception of the skin exam that showed large confluent blisters draining yellow-green pus (See Image 1) and erythem-atous macular lesions on his left wrist (See Image 2). The skin surrounding the blisters was ex-quisitely tender and the blisters were friable and easily unroofed. The lesions predominantly af-fected the left side of his body with evidence of lymphatic spread. He was diagnosed with Spo-rotrichosis and treated with itraconazole 200mg twice daily for a total of 22 days (14 days after all lesions resolved). Skin lesion fungal cultures and stains yielded no organisms. He recovered well without evidence of dissemination. Further clarification revealed that he had fallen on a rose shrub. This case was a dramatic presentation of a lymphocutaneous disorder.

Reference:

1. Longo, Dan L., Dennis L. Kasper, J. Larry Jameson, Anthony S. Fauci, Stephen L. Hauser, and Joseph Loscalzo. Harrison’s Principles of Internal Medicine. 18th ed. Vol. 1. N.p.: McGraw Hill, 2012. Print.

Author information:

Jasna Ikanovic, MD, is a PGY2 Internal Medicine Resident at Carolinas Medical Center in Char-lotte, NC.

Animita Saha, MD, is a Faculty Member of the Internal Medicine Residency at Carolinas Medi-cal Center in Charlotte, NC.