A Nonhealing Ulcer With Secondary Enlarging Nodules in a Linear Distribution

AUTHORS:
Gavin Cardwell, DO • Matthew Willet, MD • John Landers, MD

AFFILIATIONS:
Naval Medical Center San Diego, California

CITATION:
Cardwell G, Willet M, Landers J. A nonhealing ulcer with secondary enlarging nodules in a linear distribution. Consultant. 2021;61(1):17-19. doi:10.25270/con.2020.06.00018

Received February 27, 2020. Accepted June 8, 2020.

DISCLOSURES:
The authors report no relevant financial relationships.

DISCLAIMER:
The views expressed in this article are those of the authors and do not necessarily reflect the official position of the institution, the Department of the Navy, the Department of Defense, or the United States Government.

CORRESPONDENCE:
Gavin Cardwell, DO, Naval Medical Center San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134 (gcardwell67@yahoo.com)

A 19-year-old man on active military duty presented with a nonhealing ulcer on his dorsal right hand accompanied by enlarging nodules in a linear distribution on his right arm and forearm (Figure 1). Approximately 1 year prior to the onset of symptoms, the patient’s right hand had been struck by a shovel while he had been conducting field exercises in the Southwestern United States. This wound had evolved into a painless ulcerated nodule (Figure 2). Subsequently, nodules had developed on the dorsal aspect of his right wrist and had progressed in a linear pattern to include his dorsal forearm and arm. He denied fevers, chills, weight loss, or other constitutional symptoms. He had no relevant medical history and no known animal exposures or bites.

Figure 1. A nonhealing ulcer on the patient’s dorsal right hand accompanied by enlarging nodules in a linear distribution on the right arm. Nodules are distinguished by black ink from a skin marker.

Figure 2. A nonhealing , painless, ulcerated nodule on the patient’s dorsal right hand.