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JAMA Clinical Challenge
November 26, 2014

Rapidly Progressing Leg Ulcer With Fever in a Woman With Chronic Diarrhea

Author Affiliations
  • 1Department of Dermatology, Second Xiangya Hospital, Central South University, Changsha, China
JAMA. 2014;312(20):2158-2160. doi:10.1001/jama.2014.13007

A 27-year-old woman presents with a rapidly progressing painful ulceration on the left leg (Figure) with intermittent high fevers. The lesion began as 2 sesame seed–sized violaceous, papulovesicular rashes with an erythematous halo on her left medial malleolus 12 days prior to presentation. Within 1 week, more papulovesicles appeared, merged, and ulcerated spontaneously (Figure, A and B). The ulceration expanded outwardly at a rapid pace, with increasing pain and a hemorrhagic exudative discharge (Figure, C [left panel]). The lesion did not respond to treatment with systemic antibiotics, including vancomycin and meropenem. During the prior 5 months, she experienced mild diarrhea, which was ultimately diagnosed as Crohn disease by colonoscopy with biopsy.

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