A 47-year-old male presented with fever of 39 °C, headache, and malaise that had begun upon his return from a vacation in South Africa. Five days previously, he had developed a painless violaceous plaque with a central eschar over the right popliteal fossa after having attended a wildlife safari. No insect bite was remembered. Further examination revealed palpable, painless inguinal lym-phadenopathy. Routine laboratory tests showed an elevated C-reactive protein (1.46 mg/dl), with no other abnormal parameters. Histology revealed ulcerated necrosis accompanied by a dense lymphohistiocytic infiltrate, with signs of vascular injury in the superficial and deeper dermis, including intramural and perivascular infiltration with endothelial swelling and vascular fibrinoid necrosis (Figs. 1 and 2).
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