Clinical Challenge: A Nodular Lesion on the Nose of Patient with Dyspnea

A 48-year-old black female presents with a nodular lesion on the nose. In addition to the skin findings, she has dyspnea.

A chest radiograph shows bilateral hilar lymphadenopathy, and a skin biopsy shows non-caseating granulomas. Special stains for fungus and acid-fast bacteria are negative.