A 16-year-old African American boy presented to the emergency department with a 2-week history of an enlarging focus of erythema and induration over his right elbow. His symptoms reportedly began with the localized onset of pruritic papules that coalesced to form a large plaque. After 1 week, the region had become markedly indurated, with weeping of serous fluids, and the patient was seen by a local physician, who prescribed cephalexin. Despite the antibiotic therapy, the inflammation and induration continued to worsen.