Description

A 35-year-old man with no known medical history presented to an outpatient clinic, with a warm, erythematous, tender skin lesion that was draining purulent fluid, on his left medial lower extremity (figure 1). The patient denied any similar events and was lacking other systemic symptoms. Vital signs were normal. The remainder of the physical examination was benign. Incision of the lesion yielded purulent drainage that was sent for culture. The wound was then washed with sterile saline and packed with cotton gauze; an elasticised dressing was applied over the top. The patient was given oral doxycycline with instructions to return the next day. Approximately 12 h later, the patient returned with symptoms of worsening left leg pain. The external dressing was removed from the lesion, revealing a black necrotic centre with expanding erythematous borders (figures 2 and 3). Purulent ‘fuzzy’-appearing discharge was noted …