A 5 month old boy with failure to thrive developed erythroderma shortly after birth. At several months of age pustules and nodules erupted on his legs and disseminated over his arms and legs. An extensive laboratory evaluation shows an IgE level of 19,000 I; other studies are normal or pending. A skin biopsy of the erythroderma showed a chronic dermatitis; biopsy of a nodule on the foot demonstated granulomatous inflammation with multiple organisms on acid fast stain. Cultures eventually grew Mycobacterium fortuitum, and the nodules and abscesses cleared on antibiotic therapy. One month later these violaceous papules and nodules remained. A skin biopsy at this time showed granulomatous inflammation, but special stains and cultures were negative for mycobacteria.
