case_images: PMC9647289_01
case_images: Erythematous and excoriated papules with post-inflammatory hyperpigmentation
  and scarring diffusely spread on bilateral legs and feet.
case_images: 10.1177_2050313X221136008-fig1.jpg
case_images: PMC9647289_01_10.1177_2050313X221136008-fig1.jpg
case_images: fig1-2050313X221136008
case_images: Post-inflammatory hyperpigmentation was prominent on bilateral legs and feet, with some scarring present (Figure 1).
case_images: Prurigo papule. Superficial epidermal erosion with serum crusting, epithelial
  hyperplasia and reactive dermal inflammation and fibrosis (H&E, original
  magnification 40x)
case_images: 10.1177_2050313X221136008-fig2.jpg
case_images: PMC9647289_01_10.1177_2050313X221136008-fig2.jpg
case_images: fig2-2050313X221136008
case_images: Punch biopsies obtained from the right dorsal forearm and right buttock showed erosion, prurigo nodule-like changes, and healing skin response (Figure 2).
case_images: (a) Posteroanterior chest x-ray image exhibiting right paramediastinal and
  perihilar opacities concerning for lymphadenopathy and/or neoplasm.(b)
  Lateral chest x-ray image exhibiting right paramediastinal and perihilar
  opacities concerning for lymphadenopathy and/or neoplasm.
case_images: 10.1177_2050313X221136008-fig3.jpg
case_images: PMC9647289_01_10.1177_2050313X221136008-fig3.jpg
case_images: fig3-2050313X221136008
case_images: A 2-view chest x-ray (Figure 3(a) and (b)) was concerning for lymphadenopathy or neoplasm due to presence of right paramediastinal and hilar opacities.
case_images: (a) Coronal view of chest CT with contrast showing large anterior mediastinal
  mass with anteroposterior, transverse, and vertical dimensions of
  7.8 cm x 1.5 cm x 12.7 cm with additional mediastinal and perihilar
  lymphadenopathy. (b) Sagittal view of chest CT with contrast showing large
  anterior mediastinal mass with anteroposterior, transverse, and vertical
  dimensions of 7.8 cm x 1.5 cm x 12.7 cm with additional mediastinal and
  perihilar lymphadenopathy.
case_images: 10.1177_2050313X221136008-fig4.jpg
case_images: PMC9647289_01_10.1177_2050313X221136008-fig4.jpg
case_images: fig4-2050313X221136008
case_images: A chest computed tomography (CT) scan with contrast revealed a large right anterior mediastinal mass (7.8 cm x 1.5 cm x 12.7 cm) with intrathoracic lymph node involvement (Figure 4(a) and (b)).