Violaceous skin lesions on a returned traveller

Abstract

Violaceous skin lesions on a returned traveller Clinical recordA 34-year-old Australian man, with no relevant past medical history, presented to the emergency department with 4 weeks of progressive, nodular skin lesions on his non-dominant hand and arm (Box 1, A). He was systemically well, without constitutional symptoms, and worked as a plumber in suburban Melbourne. He was an avid gardener and had completed a 4-week permaculture course in Pisac, Peru, 8 weeks prior. While in Peru, he sustained multiple insect bites and scratches on his hands while working with soil. He had no animal bites or fresh or salt water exposure. He completed a 5-day course of cephalexin with his local doctor, without improvement, upon the emergence of the first lesion on this thumb.Examination revealed a well man, with multiple large, tender, violaceous, lesions tracking up his left arm. The lesions were raised, warm and ulcerated. Larger lesions were fluctuant, with serous discharge (Box 1, A). The remainder of his skin and physical examination was normal with no lymphadenopathy and normal vital signs. Medical educationMJA 215 (9) ▪