Figure 2. Satellite Lesions of Pyoderma Gangrenosum.

A previously healthy man in his 40s presented with an ulcerating purpuric, violaceous plaque with undermined borders on his right leg and multiple satellite lesions after recent methamphetamine use. Despite negative tissue cultures and failure to respond to multiple systemic antibiotics, he received a necrotizing fasciitis diagnosis because of his sepsis-like presentation and his expanding leg ulcer. An amputation occurred at an outside hospital. After a hospital transfer, in which a diagnosis of necrotizing neutrophilic dermatosis was made, he had rapid clinical improvement after receiving systemic corticosteroid therapy.