Author/Authors :
SANTOS, Vitorino Modesto Catholic University (UCB) - Armed Forces Hospital (HFA) - Internal Medicine, Brazil , SOARES, Liliane Aparecida Armed Forces Hospital - Internal Medicine Department, Brazil , MACHADO, Natália Polidorio Catholic University (UCB) - Armed Forces Hospital (HFA) - Internal Medicine, Brazil , SILVA, Fernanda Gama Neves Catholic University (UCB) - Armed Forces Hospital (HFA) - Internal Medicine, Brazil , SANTOS, Valéria Araújo Nascimento Armed Forces Hospital - Pathology Division, Brazil
Abstract :
A 53-year-old woman, who was submitted to saphenectomy 20 years ago, was admitted with a painful ulcer over the right medial malleolus. She was tobacco-smoker (16 pack-years) and had high blood pressure. The skin change appeared 30 days before, following an insect bite. Firstly, there was a papule, which evolved as an ulcer in three weeks. She related that her domestic dog was recently sacrificed by the Zoonoses Control Department due to visceral leishmaniosis. Physical examination revealed an ulcerated lesion (4 cm in diameter) with irregular borders in her right medial malleolus, with hyper pigmented area associated with inflammatory signs and draining serous secretion (Figures 1A and 1B).
