Chronic skin eruptions preceding a cavitating lung lesion.

A24-year-old woman had been followed since 1984 at another institution for recurring skin lesions. The lesions were nonpruritic and would begin as papules before rupturing and becoming necrotic. An initial skin biopsy had been interpreted as being consistent with infected sebaceous cysts. The lesions persisted despite treatment. One episode of otitis media occurred. Symptoms compatible with purulent and hemorrhagic rhinitis were also elicited. In December of 1986, the patient developed fever, cough, and hemoptysis. An infiltrate was noted in the superior segment of the left lower lobe on chest x-ray examination. Antibiotic therapy was initiated and clinical improvement was noted. A followup chest x-ray film (Fig 1) was obtained. A cavitary lesion was found in the superior segment of the left lower lobe. A repeat skin biopsy was done. The patient was referred to this institution for further evaluation. On physical examination, the patient was afebrile with a respiratory rate of 18 and blood pressure of 108/72 mm Hg. She did not appear acutely or chronically ill. Examination of the eyes, ears, nose, mouth, pharynx showed no abnormalities. There was no organomegaly Examination of the skin was remarkable