PMC9731971_01
A, The patient's second presentation with irregular hyperkeratotic violaceous nodules spanning the dorsal fourth and fifth metacarpophalangeal joints and the proximal forearm in sporotrichoid distribution. B, Patient at 2 months follow-up after treatment with doxycycline and azithromycin.
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PMC9731971_01_gr1.jpg
fig1
The patient presented again to dermatology with 2 irregular hyperkeratotic violaceous nodules spanning the dorsal fourth and fifth metacarpophalangeal joints and the proximal forearm in sporotrichoid distribution (Fig 1, A). At 2 months follow-up there was significant improvement of the lesions (Fig 1, B).
A, Neutrophilic aggregates in the dermis with abscess formation. Basophilic granules are present within the neutrophil aggregates. No organisms highlighted by gram, periodic acid-Schiff, Grocott's methenamine silver stain, or Fite stains. B, Magnified image of neutrophilic aggregates.
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PMC9731971_01_gr2.jpg
fig2
Punch biopsy of the lesion demonstrated neutrophilic aggregates in the dermis with abscess formation (Fig 2).