Skin Tumor in a Woman With Respiratory Distress

REPORT OF A CASE  A 57-year-old woman presented complaining of shortness of breath. She had multiple skin nodules of unknown duration. She noted pleuritic chest pain, night sweats, and fevers. She had a cough productive of white sputum for 1 year and generalized weakness. She lost 18 kg over the past 2 years.The patient quit smoking 2 months before but had a 10 pack-year history. At that time she also stopped her 0.25 L/d alcohol intake. Her history was significant for a seizure disorder for which she took phenytoin (Dilantin).Physical examination revealed multiple 1-cm nodules on her trunk without changes in the overlying skin. A 2-cm mass with a central erosion was found on her posterior left thigh (Figure 1).A chest roentgenogram showed bilateral interstitial and alveolar infiltrates and a left pleural effusion. She was treated for presumptive Pneumocystis pneumonia but her respiratory distress worsened. Two days