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History: A 51 year old African American female was admitted to Barnes/Jewish Hospital with a six week history of lesions involving the groin, inframammary folds, axilla, and back. She stated the lesions began as "blisters" that progressed to nonpainful, slightly pruritic wart-like growths. She also reported having a tongue lesion several months ago that resolved. She had been treated as an outpatient with tetracycline (500 mg po bid) without improvement. Prior to admission, she was started on Lamisil, Diflucan, Levaquin, and Flagyl by her PMD. On admission, she had a low-grade fever but denied other constitutional symptoms. A dermatology consult was called.
Physical examination: On physical examination, the patient had
well-demarcated vegetative plaques on her groin, inframammary areas, axilla,
and intergluteal area. Scattered crusted erosions were located at the periphery
of the plaques. She had a small vegetative, macerated plaque on her superior
intergluteal region. Similar plaques were found on her bilateral inframammary
folds and axilla. Several annular eroded plaques were noted on her back.
In addition, she had two ulcers with white fibrinous debris on her left
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