A nonhealing ulcer with secondary enlarging nodules in a linear distribution
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.
