The patient was a 17-year-old Negro male from
Cahuita (Limon, Costa Rica), admitted to the hos
pital in June 1980. A month before seeking med
ical attention, he sustained blunt trauma to the nose from a coconut, while he carried these fruits
from the seashore. Several days after this episode,
he noticed a rapid painless swelling of the frontal
and lateral sides of the nose, associated with nasal
obstruction and watery discharge. A few days lat
er, a prominent subcutaneous nodule appeared in
the frontal region. Except for these lesions, the
clinical examination was essentially negative. The nose and paranasal tissues were much enlarged by
diffuse thickening of the skin. This was especially