A 59-year-old man presented with chronic nonhealing ulcerations on his arms and legs that had persisted for several months. His medical history was notable for a several-year history of polymyalgia rheumatica, which had been treated with oral prednisone and, occasionally, methotrexate, as well as for amputation of the lower part of his left leg 1½ years earlier because of necrotizing fasciitis. The skin ulcerations had progressed markedly over the last few months, although the polymyalgia rheumatica was asymptomatic as a result of the prednisone therapy (50 mg/d). Empirical therapy with penicillin G tetrahydrate and ciprofloxacin hydrochloride had been initiated 2 to 3 weeks earlier, with no improvement. The patient had mild pain in the upper abdominal area, with no other signs or symptoms of distress, but he seemed to be euphoric.
von Stebut E, Wiest K, Braeuninger W. Chronic Infiltrates and Persisting Ulcerations on the Arms and Legs—Quiz Case. Arch Dermatol. 2005;141(7):897-902. doi:10.1001/archderm.141.7.897-e