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October 2007

Beefy Red Plaque in the Popliteal Fossa—Quiz Case

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Arch Dermatol. 2007;143(10):1323-1328. doi:10.1001/archderm.143.10.1323-d

A 27-year-old woman was evaluated for painful skin lesions present on her right leg for 2 months. They initially appeared as small pustules, then progressively increased in size and developed a purulent surface exudate. One day prior to presentation she underwent incisional biopsy of the right talonavicular joint for suspected osteomyelitis. She had been diagnosed with “walking pneumonia” 2 weeks prior. The patient was healthy and denied immunosuppression.

Physical examination revealed a 4 × 2-cm beefy red plaque with creamy exudate in the right popliteal fossa (Figure 1) and a 5-mm erythematous indurated papule on the right lateral thigh. There was no lymphadenopathy. A potassium hydroxide touch-preparation smear was performed, and a shave biopsy specimen from the right popliteal fossa plaque was stained with hematoxylin-eosin (Figure 2) and periodic acid–Schiff (Figure 3).

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