Brazilian landscaper with nodules in linear configuration on hand – Let’s diagnose

A 46-year-old, immunocompetent commercial landscaper in Brazil presented to the doctor with an evolving eruption that had developed on her hand and spread to her forearm over the past few weeks. The patient did not recall any specific injury to her arm but noted that she was regularly exposed to toxic plants and sustained minor scratches and cuts at work. She wondered if this was an allergic response to a toxic plant or a response to bug bites. On examination, smooth, scaly and crusted, erythematous nodules in a linear configuration were seen on her dorsal hand and forearm. She had no systemic symptoms and appeared well.

What’s the diagnosis?

  1. Rocky Mountain spotted fever
  2. Sporotrichosis
  3. Mycetoma
  4. Melioidosis

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