Please help - Insect bite?

Good Evening,
This question is for my Brother-in-law.  He recently visited India and returned to Ireland.  Shortly after returning, he developed a severe infection of the skin which appears to be insect bites.  The pain became severe to the point he had to be admitted at a Dublin Hospital for a week.  The doctors did a blood culture and biopsy etc., however, could not find the cause.  The lesions (or bite marks) disappeared after a few weeks.  However, he just developed the same condition this week.  It seems to be coming up at the lower extremities.  Any help would be greatly appreciated.  I'm attaching a few pictures for your attention.  He does not have any fever or any other symptoms.  He mentioned the pain is severe in the area...unlike a mosquito bite...
Thanks!  JP.

[Bhupinder Kaur, MD]

Hello,
I cannot confirm without examination but it does not look like insect bite to me. It can be erythema nodosum..It results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees.

Diagnosis is by physical examination and biopsy of the lesion. Other lab investigations like complete blood count, ESR,ASO titer, urinalysis, throat culture, intradermal tuberculin test, and chest x-ray may also be done.

I would recommend a physician/dermatologist’s evaluation. Treatment depends on the confirmation of diagnosis. I sincerely hope that helps. Take care and please do keep me posted on how your brother is doing.