History: A 55 year old black male presented with a six month history of "pus bumps" on his hands that would drain spontaneously, slowly resolve and then be replaced by new lesions. During the two days prior to admission, he had noted fever to 102' F and was unable to walk due to increasing pain in his right ankle. He denied any history of trauma, gout, rheumatoid arthritis or sexually transmitted diseases. PMH was significant for adult onset diabetes mellitus, hypertension and chronic renal insufficiency.
Physical Exam: Numerous pale yellow, 0.2- 10 mm dermal nodules on the bilateral palms and lateral aspects of his fingers (Figs. A-C). Some demonstrated a chalky exudate, others were ulcerated with a foul odor. The right index finger was completely gangrenous. The olecranon bursa was markedly thickened and numerous subcutaneous nodules were palpable. The right ankle was erythernatous and swollen. The feet and toes were within normal limits.
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