May 2008

Fig.1

History: A 49-year-old Caucasian woman presented with a 2-month history of a painful, ulcerated nasal plaque. Previous shave biopsies showed non-specific granulomatous changes. Trials of cephalexin, rifampin, and trimethoprim sulfamethoxasole were not beneficial. Concurrent medications included prednisone 7.5 mg daily, methotrexate 10 mg weekly, and adalimumab 0.8 ml by subcutaneous injection weekly for seronegative rheumatoid arthritis. Family and social history were non-contributory.

Physical exam: Significant for a red, ulcerated plaque on the nasal tip extending around the alar rim and into the right nares producing mild obstruction of the right nostril (Figure 1).

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