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Crusted Papules on the Bilateral Helices and Lobules.

A healthy 42-year-old Japanese man presented with painful lymphadenopathy and fevers of 1 month’s duration as well as a pruritic rash and bilateral ear redness and crusting of 1 week’s duration. He initially was seen at an outside facility and was treated with antibiotics and supportive care for cervical adenitis. During clinical evaluation, he denied joint pain, photosensitivity, and oral lesions. His medical and family history were noncontributory. Although he reported recent travel to multiple countries, he denied exposure to animals, ticks, or sick individuals. Physical examination revealed erythematous blanching papules on the nose and cheeks (top) as well as crusted papules coalescing into plaques on the bilateral helices and lobules (bottom).