MARY S.STONEMDSOONBAHRAMIMDCARRIE ANN R.CUSACKMDSENAIT W.DYSONMDMOLLY A.HINSHAWMDVINCENTLIUMD
A 16-year-old girl presented with a 2-month-history of an erythematous papule on her chin that had slowly progressed to a painless crusted ulceration with raised indurated borders (Figure 1). She was treated empirically with a 2-week course of trimethoprim-sulfamethoxazole therapy for presumed methicillin-resistant Staphylococcus aureus at an outside institution, without clinical improvement. Although there was no evidence of mucosal involvement, additional lesions appeared on her face and trunk. Her recent travel history included a trip to Costa Rica 2 weeks before the appearance of the initial lesion. She denied systemic symptoms, including fatigue, fever, abdominal pain, or weight loss. A punch biopsy specimen was obtained from the indurated border of the lesion on her chin (Figure 2 and Figure 3).
Martin JE, Hsu M, Werchniak AE. Ulcerated Plaque on the Chin of a Young Woman—Quiz Case. Arch Dermatol. 2010;146(7):789-794. doi:10.1001/archdermatol.2010.151-a