A young woman presented to the office with several days of overall malaise, fever, and sore throat. At the time of presentation she noted some painful bumps on her lower legs, and denied trauma (Figure 178-1). No history of recent cough or change in bowel habits has been reported. The patient had no chronic medical problems, took no medications and had no known drug allergies. Her temperature was slightly elevated, but other vitals were normal. On examination, her oropharynx revealed tonsillar erythema and exudates. Bilateral lower extremities were spotted with slightly-raised, tender, erythematous nodules that varied in size from 2 to 6 cm. Rapid strep test was positive and she was diagnosed clinically with erythema nodosum (EN) secondary to group A β-hemolytic Streptococcus. She was treated with penicillin and NSAIDs, and was advised temporary bedrest. She experienced complete resolution of the EN within 4 weeks.