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Previous Volume 350:1442 April 1, 2004 Number 14 Next

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View larger version (56K): [in this window] [in a new window]   A 23-year-old Peace Corps volunteer lived in a traditional mud hut with a thatched roof in a rural savannah village in Gambia. Several painless ulcers developed on his lower legs during a three-month period. The lesions did not respond to local antimicrobial therapy (2 percent fucidic acid ointment applied four times daily for one week) or systemic antimicrobial therapy (500 mg of floxacillin four times a day for two weeks). A typical lesion was a clean ulcer with a raised, purplish, indurated edge. The diameter was similar to that of a Gambian dalasi, which is 3.1 cm. The patient had not previously traveled outside the United States. What is the diagnosis? Editor's note: We invite our readers to submit their answers at www.nejm.org/mystery. We will publish the diagnosis in the Correspondence section of the May 27, 2004, issue and e-mail it to everyone who submits an answer. All answers must be received by April 15, 2004.

 

Stephen Morris-Jones, M.R.C.P.
Martin Weber, M.D.
Medical Research Council Laboratories
Fajara, Gambia

Related Letters:

Medical Mystery: Painless Ulcers — The Answer
Morris-Jones S., Weber M.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:2313-2314, May 27, 2004. Correspondence

This article has been cited by other articles:

• Morris-Jones, S., Weber, M. (2004). Medical Mystery: Painless Ulcers -- The Answer. NEJM 350: 2313-2314 [Full Text]