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A man aged 42 years with a history of hypertension presented with asymptomatic, erythematous papules on his trunk, neck, and upper extremities. He first noted lesions on his arms. Although nonpruritic, he assumed they were bug bites. Over a span of three weeks, new spots cropped up quickly, yet the older spots had not resolved. There were soon too many to count. Examination revealed firm, mobile, nontender pink papules ranging from 4 to 12 mm in diameter. The patient’s face, hands, and feet were unaffected. Review of systems was significant for a 10-lb weight loss, fatigue, and dyspnea of two weeks’ duration.

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