Dermatology Case Challenge: Painful Lesions, Open Wounds on a 45-Year-Old Woman

Poornima Oruganti, MD, MPH; Jason Schairer, MD


October 10, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A 45-year-old African American woman presents with lesions on her legs. She has a history of hypertension, type 1 diabetes, and jejunal Crohn's disease, which was diagnosed 15 years ago. The patient injured her right leg 2 months earlier while riding her bicycle. The lesion was painful, weeping, and ulcerated but now appears to be healing. She also has a larger lesion on the left leg. She has not experienced nausea, vomiting, diarrhea, constipation, abdominal pain, melena, and hematochezia.

Her small-bowel Crohn's disease was diagnosed when she was 30 years old and was well-controlled for many years. She is currently taking azathioprine only. The patient was hospitalized for a flare of her Crohn's disease about 6 months ago and required intravenous corticosteroids along with a steroid taper.

The patient's mother has hypothyroidism. Her father has coronary artery disease and hypertension. She has no siblings. The patient quit smoking 5 years ago and does not drink alcohol.


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