Tender ulcerated pustular plaques on the dorsal hand

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A 45-year-old white man presented to the emergency department (ED) with a three-week history of large tender plaques that had started as pustules on the dorsal hand. The plaques had ruptured and were draining purulent fluid. The man also reported significant malaise and low-grade fevers. A 72-hour trial of cephalexin yielded no improvement, and the patient was admitted for IV vancomycin. After 48 hours, the patient left the hospital against medical advice, but he returned to the ED the following day.

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