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A right-hand dominant man in his 50s who, six weeks previously, had undergone washout of a volar thumb wound, presented to the plastic surgery clinic with a one week history of erythematous cutaneous nodules over the left thumb and dorsoradial forearm (fig 1). The wound, which was painful and swollen, had been attributed initially by the patient to an infected splinter, but no foreign body had been found on surgical exploration and routine microbiological wound cultures were negative. The patient did not report systemic symptoms such as fever, and there was no palpable lymphadenopathy on examination.