Figure 1. Ulcerative lesion located on the thigh and hands.

 

 

 

 

 

Figure 2. Large abscess of the patient’s left shoulder with redness and bulging.

  A 40-year-old lady referred to our clinic with a five year history of recurrent skin abscess and nonhealing ulcerative lesions located on the upper two-thirds of both thighs and hands with associated serous drainage, tenderness and erythema. Intermittently, each abscess ruptured and spontaneously drained and was followed by scar formation as seen in Figures 1. During the previous 12 months, the patient had received multiple courses of oral antibiotics and antifungal medications that were ineffective. There was a history of progressive weight loss. Upon admission, the patient’s vital signs were normal. There was a large abscess on the posterior aspect of left shoulder with fluctuation and tenderness (Figure 2). The abscess was aspirated and sent to the laboratory for smear and culture. Skin biopsies were performed from the skin lesion of the leg and were sent for histopathological examination. There was no clinical or laboratory evidence for infectious diseases such as HIV, autoimmunity, or hematological abnormalities. Laboratory results showed the following abnormalities: Hb 8 g/dL and CRP 2+. Purified protein derivate (PPD) skin test was positive with 17 mm of induration seen at the 48^th hour. Erythrocyte sedimentation rate was 120 mm/hr. The patient’s chest X-ray was normal.