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JAMA Dermatology Clinicopathological Challenge |

Ulcerated Plaque With Lymphocutaneous Spread QUIZ

Evan W. Piette, MD1; Karolyn A. Wanat, MD2; Douglas J. Pugliese, MD, MPH1
[+] Author Affiliations
1Department of Dermatology, University of Pennsylvania, Philadelphia
2Department of Dermatology, University of Iowa Hospital and Clinics, Iowa City
JAMA Dermatol. 2015;151(8):895-896. doi:10.1001/jamadermatol.2015.75.
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This case study describes a woman with an ulcerated plaque on the forearm after a hospital admission for congestive heart failure. Histopathologic examination of a 4-mm punch biopsy specimen demonstrated marked superficial and deep inflammation composed predominantly of neutrophils with associated tissue necrosis. What is the diagnosis?

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A, An ulcerated plaque on the right forearm. Note 2 tender, 1- to 2-cm red nodules in the right antecubital fossa. B, Dense neutrophilic infiltrate. Note associated tissue necrosis. Hematoxylin-eosin, original magnification ×20. C, Organisms seen on Gram stain. Original magnification ×60.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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