A 50-Year-Old Farmer with Flu-Like Symptoms

The patient, age 50, is a farmer who presents with flu-like symptoms—fever, chills, productive cough, myalgia, and pleuritic chest pain that developed over a few weeks. What worried him most, however, was a crusted lesion on his arm that was a large verrucous scaly plaque.

View the photo and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.