Necrotic ulcers on the abdomen

Case presentation

A 50-year-old woman is being evaluated for a 2-month history of painful ulcerations on the lower abdomen associated with loss of appetite, night sweats, weight loss, and fever. Physical examination demonstrates a large painful, necrotic ulcer with elevated erythematous and scalloped borders on the lower abdomen and a few smaller adjacent ulcers in various stages of healing (Fig 1). Bacterial cultures of the ulcer are negative, and the ulcer is unresponsive to broad-spectrum antibiotics. A biopsy specimen is obtained (Fig 2), showing ulceration and a patchy dermal infiltrate of medium pleomorphic lymphoid cells (Fig 2A and 2B). Immunohistochemistry staining is performed for CD3 (Fig 2C), CD56 (Fig 2D), perforin (Fig 2E), and EBER by in situ hybridization (Fig 2F).

Fig 1.

Fig 2.

What is the most likely diagnosis?

• A.Pyoderma gangrenosum
• B.Ecthyma gangrenosum
• C.Polyarteritis nodosa
• D.Lymphoma
• E.Calciphylaxis

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Conflicts of interest

The authors have no conflicts of interest to declare.