Acta Dermato-Venereologica 99-9CompleteContent | Page 27

839 Non-healing Erythematous, Ulcerated Lesion on the Hand: A Quiz Iwona CHLEBICKA 1 , Aleksandra STEFANIAK 1 , Zdzisław WOŹNIAK 2 and Jacek C. SZEPIETOWSKI 1 1 Department of of Dermatology, Venereology and Allergology, and 2 Department of Pathomorphology, Division of Pathomorphology, Wroclaw Medical University, 50-368 Wroclaw, Poland. E-mail: [email protected] A 62-year-old woman, who worked as a seamstress, pre­ sented with an itchy, erythematous, scaly plaque on the dorsum of her fifth finger and the interdigital space 4/5 of her right, dominant hand. Physicians had diagnosed eczema 4 years previously, and had prescribed topical glucocorti­ costeroids. She reported having had breast cancer on the left side, which had been treated with mastectomy and adjuvant chemoradiotherapy 15 years previously, and had remained relapse-free. Differential diagnosis included skin cancer and chronic infection/inflammation. Biopsy revealed areas of dermal- subcutaneous necrobiosis surrounded by a granulomatous infiltrate exhibiting Langhans giant cells. PCR on paraffin- sections was positive for Mycobacterium tuberculosis. The initial tuberculostatic regimen consisted of rifampicin 10 mg/kg/day, isoniazid 5 mg/kg/day, pyrazinamide 25 mg/kg/ day and ethambutol 15 mg/kg/day for a period of 2 months, to be continued with isoniazid and rifampicin for a further 4 months. The plaque improved with treatment, but did not resolve completely. At one year follow-up the patient presented with a progressive, ulcerated nodule at the same location (Fig. 1). What is your diagnosis? See next page for answer. Fig. 1. Erythemato-desquamative ulcerated lesion on the hand. QUIZ SECTION This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3205 Acta Derm Venereol 2019; 99: 839–840