PMC3966098_01
(a, b) Nodular rash around the left and right elbows developed few hours after the insect bite; (c) absence of any rash in the lower limbs during the first visit; (d) erythema nodosum bilaterally 48 h after the first visit; (e) purpuric rash in both lower limbs 1 week after the second visit
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F1
A 26-year-old farm laborer presented to our outpatient department (OPD) with a nodular rash that had developed on both elbows [Figure 1a and b] following an insect bite while she sleeping. She had pruritus over the affected areas and her lower limbs as well, but without any rash [Figure 1c]. Two days later, she presented to the OPD with complaints of tender and erythematous nodules on the legs [Figure 1d]. She came back 1 week later with a purpuric rash on her lower limbs [Figure 1e], diffuse abdominal pain, and arthralgias of the knees, ankles, and elbows.