Man With Necrotizing Ulcers on the Leg

IMAGES IN EMERGENCY MEDICINE Hiske Mevius, BSc; Rogier A. M. Quax, MD, PhD; Jelmer Alsma, MD 0196-0644/$-see front matter Copyright © 2016 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2016.02.004

Figure. Indurated, slightly flaky erythematous papules, coalescing to form red-brownish plaques with ill-defined borders on the right lower leg, with 4 round to polycyclic necrotizing ulcers of 1 to 5 cm in diameter, with vital edges at the medial and lateral sides of the plaques.

[Ann Emerg Med. 2016;68:244.] A 27-year-old white man presented with progressively growing, painful, necrotizing ulcers on the right lower leg since 4 weeks earlier. He had no fever or other complaints. Physical examination of the right leg revealed indurated, slightly flaky erythematous papules, coalescing to form red-brownish plaques with ill-defined borders. There were 4 round to polycyclic necrotizing ulcers of 1 to 5 cm in diameter, with vital edges at the medial and lateral sides of the plaque (Figure).

For the diagnosis and teaching points, see page 251. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 244 Annals of Emergency Medicine

Volume 68, no. 2 : August 2016

Volume 68, no. 2 : August 2016

Annals of Emergency Medicine 251