LAUSR

A 32-year-old male was presented to the emergency department because of ulcers, eschars, and multiple reddish nodules on both arms for five days, which developed after scratching both arms owing to severe pruritus. The patient’s medical history revealed only job-related stress with occasional onychophagia. The patient denied drug abuse, abroad stays, allergies, or animal contact. Physical examination revealed ulcers of the left elbow with hardened, tender, and darkish nodules and eschars along the major superficial veins of the upper limbs (Figure 1). Duplex sonography revealed bilateral thrombophlebitis of the right median antebrachial vein and cephalic and median cubital veins (Figure 2). Elevated C-reactive protein (140 mg/L) level, leukocytosis (19.95 x 10 9 /L), and neutrophil count (12.0 x 10 9 /L) were detected in laboratory testing; however, the assessment of drug screen, urine analysis, antibodies against human immunodeficiency virus and hepatitis B and C, cryoglobulins, autoantibodies, chest radiography, and psychiatric were unremarkable. Repeated wound swabs of the ulcers were positive for group G streptococci , Arcanobacterium haemolyticum , Staphylococcus aureus, and Prevotella disiens but negative for mycobacteria and fungi. Blood cultures remained negative. Given the presence of eschars along thrombophlebitis and different bacterial species in the wound swabs, the patient was diagnosed with necrotizing polymicrobial thrombophlebitis. inflammation