Reoccurring lesions on arms of HVAC worker

Presenter: Jennifer David, DO, MBA
Dermatology Program: Larkin Community Hospital
Program Director: Stanley Skopit, DO, MSE, FAOCD
Submitted on: Oct 3, 2014

CHIEF COMPLAINT:  Reoccurring growths on forearms

CLINICAL HISTORY:

Signs and symptoms:  52 y/o Caucasian male presented to our clinic complaining of reoccurring growthes on bilateral forearms that would come and go for the past year. Lesions would begin as small pink papules that would grow over the course of a few weeks, then ulcerate and eventually self resolve

Previous Treatment:  None

Other information:  Of note, patient works as a HVAC (heating and air conditioning) repairman. When questioned about exposure to caustic materials at work, he did admit to exposure of his forearms to Freon while repairing larger units and frequently scratching his arms while reaching beneath the units.

PHYSICAL EXAM:

Left forearm- 4cm pink vegetative plaque with central ulceration and crusting on background of numerous excoriations

Right forearm- 1cm crusted ulceration on background of scattered excoriations and pink papules

Negative for cervical and axillary lymphadenopathy

 

 

LABORATORY TESTS:

Tissue cultures were negative for acid fast mycobacteria and fungal/yeast elements however did grow heavy amounts of staphylococcus aureus.

DERMATOHISTOPATHOLOGY:

Skin biopsy was performed, and the histopathology showed pseudoepitheliomatous hyperplasia with sinus tract formation, focal supprative inflammation and focal granuloma formation with gram-positive cocci within the pseudoepitheliomatous hyperplasia.

 

 

DIFFERENTIAL DIAGNOSIS:

1.   Halogenoderma
2.   Botryomycosis
3.   Mycetoma
4.   Atypical Mycobacterium
5.   Lymphomatoid Papulosis


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