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July 2005

Chronic Infiltrates and Persisting Ulcerations on the Arms and Legs—Quiz Case

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Arch Dermatol. 2005;141(7):897-902. doi:10.1001/archderm.141.7.897-e

A 59-year-old man presented with chronic nonhealing ulcerations on his arms and legs that had persisted for several months. His medical history was notable for a several-year history of polymyalgia rheumatica, which had been treated with oral prednisone and, occasionally, methotrexate, as well as for amputation of the lower part of his left leg 1½ years earlier because of necrotizing fasciitis. The skin ulcerations had progressed markedly over the last few months, although the polymyalgia rheumatica was asymptomatic as a result of the prednisone therapy (50 mg/d). Empirical therapy with penicillin G tetrahydrate and ciprofloxacin hydrochloride had been initiated 2 to 3 weeks earlier, with no improvement. The patient had mild pain in the upper abdominal area, with no other signs or symptoms of distress, but he seemed to be euphoric.

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