REPORT OF A CASE
We were asked to evaluate a ''pressure sore'' on the back of a 65-year-old white man admitted to the intensive care unit. The patient had a history of alcoholic cirrhosis for several years, and he was transferred from an outside hospital for persistent gastric variceal bleeding. A transjugular intrahepatic portosystemic shunt was performed. Postoperatively, aspiration pneumonia developed that necessitated ventilatory support. An ulceration on the middle of the patient's back was noted during the physical examination performed on admission to our institution. The ulceration did not improve after a week of local wound care, and the dermatology service was consulted.The patient was cachectic but comfortable and responsive. A 2.5-cm dark-red nodule with a central 1-cm ulceration was noted overlying the fifth thoracic vertebra (Figure 1). Intubation precluded obtaining a complete history, but it was ascertained that the lesion was asymptomatic and had been present for