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JAMA Dermatology Clinicopathological Challenge
July 2015

Chronic, Painful, Nonhealing Ulcer on the Right Arm Following Minor Trauma

Author Affiliations
  • 1Department of Dermatology, University of Utah Health Sciences Center, Salt Lake City
JAMA Dermatol. 2015;151(7):787-788. doi:10.1001/jamadermatol.2014.5373

A man in his 50s was referred to the dermatology clinic for a chronic, painful nonhealing ulcer on the right forearm following a ground-level fall 3 months previously. He reported subjective fevers, as well as increasing erythema and tenderness immediately around the right forearm lesion. He stated that he did not have a history of poor wound healing or painful skin ulcers. He had a history of type 2 diabetes and an allogenic bone marrow transplant 1 year prior for myelodysplastic syndrome complicated by pancytopenia and chronic graft-vs-host disease. Physical examination revealed an isolated slightly erythematous, edematous plaque with a prominent central eschar on the right forearm (Figure, A). An incisional biopsy at the edge of the eschar was performed, and a specimen was sent for pathological evaluation (Figure, B-D).

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