This 48-year-old woman developed papules and nodules on the nose, eyelids, and neck followed a short while later by shingles on her back. Within several weeks this was followed by a flu-like illness with fever, chills, nausea, night sweats, weight loss of 40 pounds, persistent sinus congestion, worsening dyspnea, cough, and chest pain. Chest computed tomography demonstrated peripheral nodules in the upper lung fields and mediastinal ademopathy. Bronchoscopy revealed non-caseating granulomatous inflammation. She was treated with a slowly tapering course of oral prednisone starting at 40 mg/day with dramatic clearing of skin lesions and systemic symptoms.
symmetric discrete and confluent violaceous and hyperpigmented papules and nodules