REPORT OF A CASE
A 36-year-old homosexual man presented to the Duke University emergency room, Durham, NC, with multiple medical complaints; chief among these was an ulcer on his forehead. Three weeks previously, the patient had noticed several small blisters in the affected area. Scratching of the lesions resulted in a single painless ulcer, which progressively enlarged. A one-week course of erythromycin prescribed by his local physician for the treatment of "cellulitis" did not produce any improvement.Additional symptoms included headache, photophobia, nausea, and vomiting of three days' duration. The patient's medical history was notable for fever blisters, viral hepatitis, herpes zoster, giardiasis, amoebic enteritis, persistent oral thrush, and cytomegalovirus pneumonia, all of which had occurred during the preceding four years.Cutaneous examination revealed a shallow 5 × 20-mm, slightly tender ulcer on the patient's forehead (Fig 1). The borders of the lesion were violaceous, indurated, and raised. Other pertinent physical find