Photo Quiz

Red Tender Nodule on a Pregnant Patient

 


FREE PREVIEW. AAFP members and paid subscribers: Log in to get free access. All others: Purchase online access.


FREE PREVIEW. Purchase online access to read the full version of this article.

Am Fam Physician. 2016 Apr 15;93(8):701-702.

A 22-year-old pregnant woman (gravida 2, para 1) presented with a sore throat and tonsillar exudates at eight weeks' gestation. Group A rapid streptococcus antigen test results were positive, and streptococcal pharyngitis was diagnosed. She was treated with amoxicillin. On the seventh day of antibiotic treatment, she returned to the clinic with a tender skin nodule on her left anterior leg, and a different antibiotic was prescribed.

On physical examination, the patient had a low-grade fever and multiple erythematous nodules on both of her shins (Figures 1 and 2). The nodules were tender but had no ulceration or drainage. After no response to two weeks of oral antibiotic therapy, she was admitted to the hospital and intravenous antibiotics were initiated. A wound culture had no bacterial growth, and a complete blood count was within normal limits.


Figure 1.


Figure 2.

Question

Based on the patient's history, physical examination findings, and laboratory results, which one of the following is the most likely diagnosis?

A. Bacterial cellulitis

B. Erythema nodosum.

C. Polyarteritis nodosa.

D. Sarcoidosis.

Address correspondence to Stephen C. Brawley, MD, PhD, at stephen.c.brawley.mil@mail.mil. Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

REFERENCES

show all references

1. Blake T, Manahan M, Rodins K. Erythema nodosum - a review of an uncommon panniculitis. Dermatol Online J. 2014;20(4):22376....

2. Schwartz RA, Nervi SJ. Erythema nodosum: a sign of systemic disease. Am Fam Physician. 2007;75(5):695–700.

3. Stulberg DL, Penrod MA, Blatny RA. Common bacterial skin infections. Am Fam Physician. 2002;66(1):119–124.

4. Gota CE. Polyarteritis nodosa (PAN). Merck Manual Professional Version. http://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/vasculitis/polyarteritis-nodosa-%28pan%29. Accessed August 10, 2015.

5. Merola JF. Dermatologic manifestations of sarcoidosis. http://emedicine.medscape.com/article/1123970-overview. Accessed January 20, 2016.

This series is coordinated by John E. Delzell Jr., MD, MSPH, Assistant Medical Editor.

A collection of Photo Quiz published in AFP is available at http://www.aafp.org/afp/photoquiz.

Previously published Photo Quizzes are now featured in a mobile app. Get more information at http://www.aafp.org/afp/apps.

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at http://www.aafp.org/afp/photoquizinfo. To be considered for publication, submissions must meet these guidelines. E-mail submissions to afpphoto@aafp.org.



 

Copyright © 2016 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

Want to use this article elsewhere? Get Permissions

CME Quiz

More in AFP


Editor's Collections


Related Content


More in Pubmed

MOST RECENT ISSUE


Dec 1, 2016

Access the latest issue of American Family Physician

Read the Issue


Email Alerts

Don't miss a single issue. Sign up for the free AFP email table of contents.

Sign Up Now

Navigate this Article