Nodules on the Thigh after Brown Recluse Spider Venom Bite: A Quiz

A 42-year-old woman presented with a brown recluse spider (Loxosceles reclusa) venom bite on her left thigh. At first, she presented erythema with pain at the site of spider bite, subsequently a vesicular-bullous lesion appeared evolving into a ulcero-necrotic area associated with lymphangitis. She was treated with topical and systemic antibiotics, which resulted in improvement in her condition. Subsequently, she pre- sented 5 recurrent non-movable, firm, deep-seated nodules on her left thigh for approximately one year (Fig. 1). She was apparently healthy, and her past medical and family histories were not contributory. One lesion with a diameter of approximately 10 mm was surgically removed by excisional biopsy. What is your diagnosis? See next page for answer.