A 63-year-old white man presented with a 2-month history of a single small pustule that had progressed to irregular painful ulcerations of the penis. The ulcerations had been treated empirically with 1- to 2-week courses of oral acyclovir, fluconazole, and ampicillin–clavulanic acid, as well as intravenous vancomycin potassium, linezolid, and cefepime hydrochloride. However, none of these treatments was effective. The patient's medical history included benign prostatic hypertrophy and mild osteoarthritis, which had been treated with terazocin and celecoxib. His hobbies included golf, which involved frequent travel throughout the United States. He denied any history of trauma, sexually transmitted diseases, high-risk sexual behavior, or systemic symptoms.
Kimyai-Asadi A, Jih MH, Began DM, Mully TW, Shupack JL, Kamino H. A 63-Year-Old Man With Chronic Penile Ulcers—Quiz Case. Arch Dermatol. 2003;139(12):1647-1652. doi:10.1001/archderm.139.12.1647-a