JAMA Clinical Challenge

Cutaneous Nodule in a Young Man

Image of solitary nodule on the chest

Jianjun Qiao, MD, PhD
Hong Fang, MD
A 21-year-old male student presents with a nodule on his chest that has been progressively enlarging over 1 month. He also has a 1-month history of upper abdominal pain associated with diarrhea but without fever or chills. He was diagnosed with acute gastroenteritis and treated with oral omeprazole and ofloxacin without relief. He has lost 5 kg during the past half year. He denies any history of chronic illness or family history of cancer. Physical examination reveals left supraclavicular and cervical lymphadenopathy. A solitary asymptomatic, nontender, and indurated nodule is found on his chest (Figure). Gastrointestinal endoscopy shows multiple ulcers on the gastric fundus and gastric corpus.

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Author Affiliations: Drs Fang (fanghongzy@sina.com) and Qiao are affiliated with the Dermatology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.