Grotesque Face Secondary to Immunotherapy: Cure Circumvallating to Curse

A 45-year-old woman presented with multiple, slightly painful, reddish, nodular facial lesions that had developed at the site of Mycobacterium w vaccine injections given for her facial warts 4 weeks prior. She had not received a sensitization dose of Mycobacterium w vaccine, and all of the inflamed lesions were injected at the same time. On examination, approximately 20 erythematous, succulent nodules of variable size were noted over the cheeks and forehead (Figure 1). Some of these lesions had purulent discharge due to secondary infection. After a course of oral amoxicillin, a punch biopsy was performed from one of the nodules and submitted for histopathologic examination.