Case presentation
A 44-year-old male Hispanic farmer, presented with a 7-month history of an enlarging, painful ulcer on his back and left flank. He gave no history of preceding trauma. Previous medications included high-dose oral prednisone, cyclosporine, and topical steroids for a suspected pyoderma gangrenosum. Physical examination revealed a large crusted plaque, a central ulcer with raised edges, purulent discharge, peripheral granulation tissue and perilesional erythema with satellite pustules (Fig 1). Chest and abdominal computed tomography showed no contiguous bone involvement. A punch biopsy was performed as well as tissue culture for bacteria, atypical mycobacteria, and fungi (Figs 2 and 3).
Fig 1.
Fig 2.
Fig 3.
What is the most likely diagnosis?
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A.
Chromoblastomycosis
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B.
Cutaneous sporotrichosis
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C.
Recalcitrant pyoderma gangrenosum (PG)
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D.
Mycetoma
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E.
Disseminated zoster (DZ)
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Conflicts of interest
Conflicts of interest The authors have no conflicts of interest to declare.
Footnotes
Funding: The authors have no funding sources to declare.
IRB approval status: Not applicable.