Chief Complaint: “I have painful lumps on my skin that have been growing over the last few weeks.”

History of Present Illness:
A 27-year-old man presents with complaints of several painful, rapidly enlarging lumps under the skin on his arms, legs, and torso. The patient reports that these lumps started as small, pea-sized nodules about three weeks ago but have grown significantly since then. He describes the lumps as tender and says they are causing him significant discomfort, especially when he moves or applies pressure to the affected areas. He also noticed that his skin in the affected areas appears reddened and inflamed.

The patient mentions that he has recently been in a rural area, where he spent time outdoors and had multiple insect bites. He recalls experiencing mild fever and fatigue during the past few days but did not initially seek medical attention.

Physical Examination:

• Multiple tender, erythematous, subcutaneous nodules ranging from 2 to 5 cm in diameter, scattered on the arms, legs, and trunk
• Some nodules are fluctuant, suggesting possible abscess formation
• No obvious skin ulcers or draining pus
• Mild fever and general discomfort noted during the examination

Diagnosis:
Given the presence of painful subcutaneous nodules and the patient’s recent exposure to rural areas, streptocerciasis is suspected. Streptocerciasis is caused by the bacteria Streptococcus suis, which can lead to skin and soft tissue infections, often presenting with swollen, tender lumps in the skin. These infections can also be associated with systemic symptoms like fever and fatigue. The patient’s history of insect bites could indicate a secondary bacterial infection.

Management Plan:

• Antibiotic treatment: Initiation of broad-spectrum antibiotics, such as penicillin or amoxicillin, to treat the bacterial infection
• Pain management: Analgesics (NSAIDs) for pain and fever relief
• Drainage of abscesses: If any of the nodules appear fluctuant and filled with pus, surgical drainage may be necessary
• Patient education:
  • The importance of completing the full course of antibiotics
  • Preventing insect bites by using insect repellent and wearing protective clothing

The patient is scheduled for follow-up in 1 week to assess response to antibiotics and monitor the resolution of the skin lesions.