A 72-year-old white man came to the Department of Veterans Affairs Medical Center, Brooklyn, NY, because of a lesion above his right medial malleolus. It had begun 1 week earlier as a small, red papule that had become a pustule and then a necrotic ulcer with adherent black crust, surrounded by erythema, induration, and purpura (Figure 1). He denied trauma and local or systemic symptoms. He was in good general health, except for hypertension and stable angina, which were controlled by the use of propranolol, verapamil, and sublingual nitroglycerin.
Bhattacharya S, Lynfield Y, Sarai A, Alapati U. Fever and Rash Complicating a Leg Ulcer. Arch Dermatol. 1998;134(3):365-370. doi: