A Dome-Shaped Eyelid Nodule in a Young White Man

A 27-year-old White man presented with a recent onset of malaise, chills, night sweats, and sore throat with difficulty swallowing. He also reported redness of his right eye with watery discharge. He developed a skin rash affecting his trunk, limbs, and genitalia within the previous week. His medical history was noncontributory, except for allergic rhinitis, for which he was prescribed fexofenadrine pro re nata. His visual acuity was 6/6 in both eyes. Examination of his right eye revealed erythematous swollen eyelids. A slightly raised dome-shaped umbilicated nodule, of approximately 3 mm, was present on his medial one-third lower eyelid margin, with a similar lesion developing on the corresponding upper eyelid margin (Figure). A vesicular lesion was also present on the caruncle and there was global conjunctival hyperemia, mostly pronounced nasally and around the lesions (Figure, B). There were no signs of corneal involvement, and the anterior chamber was quiet. The left eye was normal. Results of fundus examination in both eyes were normal. No preauricular or submandibular lymph node involvement was noted, but cervical lymph nodes were enlarged. The pharynx was erythematous and swollen with white pus patches. The skin lesions were dome-shaped papules, round, pinkish-white in color, surrounded by an erythematous area. Full blood cell count and tests for HIV, AIDS, and syphilis were ordered. Conjunctival swabs and eyelid vesicle fluid were taken for polymerase chain reaction testing. Swabs of the upper respiratory tract were also taken.