PMC6297902_01
Hematoxylin-eosin stain of right forearm punch biopsy taken 7 months before hospitalization, showing spongiosis and a mixed dermal infiltrate. (Original magnification: x10.)
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A punch biopsy of the right forearm found a spongiotic mixed dermatitis with eosinophils (Fig 1).
Clinical image taken at time of hospitalization. A, Hyperkeratotic plaques and fissuring of left palm. B, Hyperkeratotic plaques and fissuring of right plantar foot. C, Hyperpigmented plaque over right ear.
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On follow-up 9 months out from his initial presentation, examination found severe fissuring and scaling of the plantar feet, purulent drainage from the toes and right ear, and massive firm adenopathy of the cervical and inguinal nodes (Fig 2, A, B, and C).