Red lesions on the extremities




CASE #1

A nonobese 28-year-old woman presented for evaluation of "ringworm" on the dorsum of her right foot. Treatment with a cream containing clotrimazole and betamethasone was ineffective. No surface disturbance could be seen, and palpation revealed induration over the entire brownish-red annular plaque, which was neither warm nor tender. The sharply defined borders of the lesion were raised slightly above the center. While the lesion was asymptomatic, its appearance was worrisome to the patient. She reported no history of diabetes, and recent testing showed normal blood glucose levels.

CASE #2

A woman presented with several painful arm lesions that had appeared abruptly 10 days earlier. Ranging in size from 1 to 3 cm, the lesions displayed a curious reddish-purple tinge and felt solid and slightly raised on palpation. They were modestly tender and considerably warmer than the surrounding skin. One month earlier, the patient had flulike symptoms (low-grade fever, chills, and myalgia). Four months prior to that, she received several vaccinations in preparation for a trip to India but had to cancel the trip because she felt so ill. Blood work showed a WBC of 13,500/μL, 80% of which were neutrophils. 

What is the diagnosis?

For CASE #1, click "NEXT." For CASE #2, click "3."

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