Rapidly progressing leg ulcer with fever in a woman with chronic diarrhea

摘要

A 27-year-old woman presents with a rapidly progressing painful ulceration on the left leg (Figure) with intermittent high fevers. The lesion began as 2 sesame seed-sized violaceous, papulovesicular rashes with an erythematous halo on her left medial malleolus 12 days prior to presentation. Within 1 week, more papulovesicles appeared, merged, and ulcerated spontaneously (Figure, A and B). The ulceration expanded outwardly at a rapid pace, with increasing pain and a hemorrhagic exudative discharge (Figure, C). The lesion did not respond to treatment with systemic antibiotics, including vancomycin and meropenem. During the prior 5 months, she experienced mild diarrhea, which was ultimately diagnosed as Crohn disease by colonoscopy with biopsy.