• Javaria Tehzeeb, Vadim Divilov, Arkar Htoo, Faye Sajjadi, and Amit Chopra.
• Department of Internal Medicine, Albany Medical Center, Albany, NY. Electronic address: javariatehzeeb2021@gmail.com.
• Chest. 2023 Apr 1; 163 (4): e167e171e167-e171.

AbstractA 21-year-old Hispanic woman with no significant medical history presented with complaints of progressive skin lesions for 3 months, associated with dyspnea and scant hemoptysis for 1 week. She initially developed painless subcutaneous nodules on her right forearm, which progressed to superficial ulcers and gradually spread to involve bilateral arms, thighs, chest, abdomen, and gluteal region. The lesions spared the head, neck, palms, and soles. She also reported fatigue and a 20-pound weight loss. An initial outpatient punch biopsy from a leg ulcer revealed nonspecific granulomatous inflammation treated with prednisone and hydroxychloroquine without improvement. A review of systems was negative for fever, chills, night sweats, arthralgias, lymphadenopathy, mucosal ulceration, or bleeding. She was born in El Salvador but had spent most of her life in New York. She did not report any recent international travel or sick contacts. There was no personal or family history of immunodeficiency or malignancies.Copyright © 2022 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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