An Active-Duty Sailor With 2 Nonhealing Painless Ulcers: What’s Your Diagnosis?

Authors:
Jason Le, DO
Naval Flight Surgeon for Command Training Wing 1 at Naval Air Station Meridian, Mississippi

Alyson J. Brinker, MD
Dermatology Resident at Naval Medical Center San Diego, California

J. Thomas Landers, MD
Staff Dermatologist and Dermatology Residency Program Director at Naval Medical Center San Diego, California

Disclosure: The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, the Department of Defense, or the US Government.

Citation: Le J, Brinker AJ, Landers JT. An active-duty sailor with 2 nonhealing painless ulcers: what’s your diagnosis? [published online August 10, 2018]. Infectious Diseases Consultant.

A 33-year-old active-duty sailor presented with 2 nonhealing, nonpruritic, painless lesions—1 on his abdomen and 1 on his back—for 2 months after having returned from a deployment in Iraq. There was no history of trauma or known insect bites to the areas. He had been self-treating the lesions with topical hydrogen peroxide and bacitracin for 2 months with no improvement or worsening. He had been sleeping in a tent while deployed. He denied any fever, chills, or other constitutional symptoms.

Physical examination revealed 2 isolated, 5-mm, pink, firm, nonmobile papules with heaped up edges and central ulceration and serous crusting, without fluctuance, located on his left upper abdomen (Figure 1) and left mid back (Figure 2). There was minimal to no tenderness to palpation. Lymph node examination findings were normal. There was no surrounding erythema, or warmth.