LAUSR

CASE REPORT A 78-year-old nondiabetic woman with a past medical history of remote pulmonary mycobacterium avium complex infection, Staphylococcus aureus osteomyelitis of the right clavicle, and SCC in situ on the right thigh presented with progressive ulceration of a long-standing plaque of NL that had been present on the right shin for 40 years. On initial examination, her right shin had a 9.0 3 25.0-cm atrophic telangiectatic yellow-pink plaque with a central 4.53 4.0-cm ulcer (Fig 1). The differential diagnosis included infection with exuberant reactive epithelial hyperplasia, vegetative pyoderma gangrenosum with or without underlying active NL, and SCC. Biopsies of the ulcer over time showed pseudoepitheliomatous hyperplasia with limited keratinocyte atypia, fibrosis, and mixed inflammation (Fig 2, A). Occult infection was ruled out by tissue cultures, microbial stains,