Erythema nodosum as the presenting feature of rheumatic heart disease.

later is associated with necrosis of skin and subcutaneous tissue leading to eschar formation. Other gradually progressive diseases presenting as discharging sin-uses in children are actinomycosis, botryomycosis, nocardiosis, and sporotrichosis. Sinus tracts of actinomycosis and nocardiosis usually discharge granules; botryomycosis is associated with subcuta-neous nodules and large verrucous (wart-like) lesions; and in sporotrichosis an ascending chain of nodules develops along skin lymphatic channels (nodular angiitis).