case_images: PMC10749176_01
case_images: Generalized multiple nodulo-ulcerative lesions on the trunk, both arms (A and B) and both legs (C and D). Erythematous plaques and nodular lesions with scales on the left arm (E, green circle), nodulo-ulcerative lesions on the back (F, red circle), and erythematous plaques with scales on the upper right arm (G, yellow circle).
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case_images: Physical examination revealed multiple erythematous papules and plaques with scales, as well as nodular and nodulo-ulcerative lesions on the trunk, both arms, and both legs (Figures 1A-D). Erythematous plaques and nodules with scales were mostly found on his extremities (Figure 1E). Nodulo-ulcerative lesions (Figure 1F) were found on his extremities and back. Other lesions, such as erythematous macules and plaques with scales (Figure 1G), erythematous papules, and nodular lesions are generalized.
case_images: Biopsy sample collected from a nodulo-ulcerative lesion on the lower back (hematoxylin-eosin staining, x20 and x40 magnifications) shows lymphocytic and plasma cells infiltration on the dermis (A) and plasma cells appear scattered on the dermis (B, red arrow).
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case_images: Histopathological examination with hematoxylin-eosin staining shows hyperplastic epidermis, a massive influx of plasma cells around fibrous connective tissue in the dermis, as well as peri-adnexal, peri-vascular, and peri-muscular lymphocytic infiltration into the deep dermis (Figure 2A and B).  
case_images: Regression of the lesion at 12 days after administration of 2.4 million units of benzathine penicillin G. The lesions evolved to become hyperpigmented macules on the trunk, both arms (A and B), and both legs (C and D). Almost all the erythematous plaques, as well as nodular and nodulo-ulcerative lesions on the left arm (E, green circle), back (F, red circle), and upper right arm (G, yellow circle) evolved to become hyperpigmented macules without scales or scars.
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case_images: Most of the lesions evolved to form hyperpigmented macules without scar formation at two weeks following treatment (Figure 3A-G).
case_images: Regression of a large nodulo-ulcerative lesion found on the left wrist (A) was seen after 12 days of treatment. The lesion became smaller, but the ulceration persisted (B). After one month following the administration of 2.4 million units of benzathine penicillin G, the large nodulo-ulcerative lesions evolved to become hyperpigmented macules without scars (C).
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case_images: A large nodulo-ulcerative lesion on the left wrist (Figure 4A) regressed after two weeks (Figure 4B), and evolved to form a hyperpigmented macule without scar formation at one month (Figure 4C).