Erythema multiforme and erythema nodosum lesions with cervical lymphadenopathy

A 39-year-old otherwise healthy woman presented to our dermatology clinic with a two-week history of a swelling and pain on her neck. She noted a low-grade fever and malaise for ten days. The patient reported no history of tick bite, new medication or consuming raw meat. Physical examination revealed fever (38.3°C), an enlarged, painful 4.5 x 4.8 cm sized lymphadenopathy in the right submandibular area (Figure 1), multiple targetoid erythema multiforme lesions on the palms (Figure 2), and multiple erythema nodosum lesions on the shins (Figure 3). We performed whole blood count, chest X-ray, serological tests (microagglutination test), fine needle biopsy, and neck ultrasonography. Histopathologic examination of the lymph node disclosed epithelioid histiocytes with multinuclear giant cells and a suppurative inflammation (Figure 4a and 4b).