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August 1996

A Palmar Chancre and Multiple Proximal Erythematous Nodules

Author Affiliations

USAF; USAF; Wilford Hall Medical Center, Lackland Air Force Base, Tex

Arch Dermatol. 1996;132(8):967-968. doi:10.1001/archderm.1996.03890320115019

REPORT OF A CASE  An otherwise healthy 70-year-old white man was referred for dermatologic evaluation of "cellulitis" of the left upper extremity, having failed to improve after 3 days of intravenous therapy with cefazolin, a first-generation cephalosporin. The patient sustained a superficial nail puncture wound of the left palm 3 weeks earlier while replacing siding on his house. He was well until 2 weeks later, when erythema, pain, and a purulent discharge from the palm developed. Medical attention was sought after the erythema spread proximally along the radial aspect of the forearm. The patient denied fever, chills, or other constitutional symptoms and continued to feel well despite the progression of his disease during antibiotic therapy. Although he gave no history of foreign travel, he resided in southern Texas near an endemic focus of leishmaniasis. His medical history was otherwise significant only for sulfonamide hypersensitivity.Our examination revealed a 5-mm ulceration

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