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September 2006

Ulcerated Plaque in a 36-Year-Old Woman—Quiz Case

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Arch Dermatol. 2006;142(9):1221-1226. doi:10.1001/archderm.142.9.1221-d

A 36-year old Cambodian woman presented with a 6-year history of a papule that had developed in a burn scar on her wrist. The lesion had slowly enlarged into a slightly painful ulcerated plaque that occasionally had a yellow discharge. The patient was otherwise healthy and denied fevers, weight loss, cough, or night sweats.

Physical examination revealed a solitary 4.0-cm, red-brown, indurated plaque with central ulceration in a scar on the dorsal aspect of the left wrist (Figure 1). No drainage was noted. No regional lymph nodes were palpable. The results of a tuberculin purified protein derivative intradermal test were positive, with a 15-mm induration, but the chest x-ray film showed no abnormalities. A cutaneous biopsy specimen was obtained for histologic analysis (Figure 2) and tissue cultures. A Fite stain was performed (Figure 3).