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JAMA Dermatology Clinicopathological Challenge
September 28, 2016

Nonhealing Lower Leg Ulcers

Author Affiliations
  • 1Botsford-Beaumont Hospital, Farmington Hills, Michigan
  • 2Department of Dermatology, St Joseph Mercy, Ypsilanti, Michigan
  • 3St Joseph Mercy, Ypsilanti, Michigan
JAMA Dermatol. Published online September 28, 2016. doi:10.1001/jamadermatol.2016.3400

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.

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