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Make the Diagnosis: This is a Bit…Fishy

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A 43-year-old woman visited her doctor about a smooth nodule that developed on her right hand 2 weeks ago. On examination, a tender, erythematous plaque with an ulcer was seen on her right dorsal hand. The patient had no recent travel history. She recalled injuring her hand a few weeks ago in the process of cleaning out her fresh-water fish tank. The patient was immunosuppressed, with a history of renal transplantation. She was asymptomatic and appeared well.

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