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July 1987

Persistent Facial Plaque

Arch Dermatol. 1987;123(7):937-938. doi:10.1001/archderm.1987.01660310105025

REPORT OF A CASE  A 31-year-old white man presented to a local university student health service with a three-week history of a slowly enlarging "deep-set pimple" on the right side of his face. He specifically denied any history of recent cough, chest pain, respiratory distress, pharyngitis, or headache. The patient had just moved to Houston from northern California, where he had spent considerable time working as a social activist tending to migrant farm workers in the San Joaquin Valley. Physical examination revealed a febrile (38°C, oral) but otherwise healthy man with a 7 × 5-cm tender, boggy, erythematous plaque on the right cheek (Fig 1). Initial treatment included hot compresses and oral ampicillin for a presumed cellulitis. After five days of this regimen, there was no improvement, so oral dicloxacillin therapy was begun. Several bacterial cultures obtained subsequently demonstrated mixed growth (Acinetobacter anitratus and Staphylococcus aureus). Nine days after initial