A 25-year-old female came to the clinic reporting a 1-day history of painful red nodules on her lower legs. She also said that her lower legs felt swollen (Figure 1). She had just started taking mefloquine 2 days before, for malaria prophylaxis prior to anticipated travel with the United States military. She had been seen in the clinic about 1 week before for fever and general joint aches, and she was diagnosed with a probable viral syndrome from which she had completely recovered. She reported no other symptoms.
She started taking sertraline for depression several weeks prior to the onset of her symptoms. She was taking no other medications and had no other medical or surgical history.
Although she had been in the Horn of Africa region, she had not gone ashore before the onset of her symptoms. She had also not traveled recently to any other foreign country.
Upon examination, the patient had tender erythematous nodular areas of varying sizes and irregular borders on both shins ( Figure 2). The lesions had no scales or other noteworthy epidermal changes. Her calves and ankles were symmetrically swollen, though without pitting edema. The rest of her examination was unremarkable. The patient was on active duty and had received a variety of immunizations and screening testing in the preceding 12 months, including recent human immunodeficiency virus and tuberculosis testing, which proved negative.
FIGURE 1
Swollen lower legs
FIGURE 2
Erythematous nodules
What is the diagnosis?
WHAT ARE THE MANAGEMENT OPTIONS?