A 12-year-old boy presented for evaluation of a 3-month history of ulcerated lesions on the dorsal aspect of his feet since returning from Pakistan, where his family was living. The patient had no history of medical problems. He was born in Spain and had received his childhood immunizations. He remembered insect bites on his feet, but the lesions later became ulcerated and painful. The patient denied experiencing fever, arthralgia, or a sore throat.
Findings from the physical examination revealed 6 painful ulcerated, exudative nodules with a grayish membrane over the ulcers on the dorsal aspect of his feet (Figure 1). No signs of lymphangitis or lymphadenopathy were detected. A 4-mm punch biopsy specimen from one lesion was obtained and stained with hematoxylin-eosin and Gram stain for histopathologic analysis. Another skin specimen was cultured for microbiologic analysis.
Sánchez MEG, Alvarez JB, León SH. Chronic Nonhealing Ulcerated Nodules in a Spanish Boy After Traveling. JAMA Dermatol. 2015;151(11):1247-1248. doi:10.1001/jamadermatol.2015.2340