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A woman aged 34 years was referred for treatment of a recurrent, painful, nonhealing ulcer of six months’ duration on her left hand. Having not responded to various antibiotics, the original ulcer (including the affected digit) had been excised and grafted. The patient was otherwise healthy and reported no associated fevers or arthralgias. Examination revealed a 3-cm ulcer with a necrotic base and surrounding erythema. A punch biopsy obtained from the erythematous border near the area of ulceration revealed a dense neutrophilic dermal infiltrate with some epidermal neutrophilic excytosis.

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