A woman in her 50s admitted for bacterial pneumonia was noted to have an ulcerated plaque on the forearm. The patient had been discharged approximately 2 weeks prior, after an admission for congestive heart failure. A few days after that discharge, the patient noticed a painful ulceration on the right distal forearm, at the site where a peripheral intravenous catheter had been inserted during her initial hospitalization. On physical examination, the patient had an ulcerated plaque on the right forearm with 2 tender, 1- to 2-cm red nodules in the right antecubital fossa (Figure, A). On further questioning, the patient noted that between her hospitalizations she had gone home and cleaned her fish tank, played with her pet cat, and gardened in her indoor cactus garden. She said she had not recently traveled, and was not taking any immunosuppressive medications. A skin biopsy and culture were performed from the forearm lesion (Figure, B and C).
Piette EW, Wanat KA, Pugliese DJ. Ulcerated Plaque With Lymphocutaneous Spread. JAMA Dermatol. 2015;151(8):895-896. doi:10.1001/jamadermatol.2015.75