A man in his 50s presented with a 2-month medical history of painful, gradually expanding ulcers on the left lower leg. The lesions started spontaneously as erythematous tender papules with white purulent discharge. He recently failed a course of amoxicillin and trimethoprim-sulfamethaxazole initiated by his primary care physician. He reported a medical history of rheumatoid arthritis (RA), chronic obstructive pulmonary disease, chronic kidney disease, and heavy tobacco use. The patient denied any recent changes to his medications or recent travel. No other household members were affected.
Reichel S, Kushner J, LaFond AA. Nonhealing Lower Leg Ulcers. JAMA Dermatol. Published online September 28, 2016. doi:10.1001/jamadermatol.2016.3400