A 55-year-old man presents with a chronic cheek ulcer. The lesion, a reddened nodule measuring 0.5 cm, had developed 2 months earlier. He was treated with cephalexin, followed by amoxicillin/clavulanate and then with moxifloxacin, but the lesion has not resolved.
It ulcerated slowly, without pain, and the patient was eventually referred to the infectious diseases service. History and Physical Examination Medical history: hypertension Medications: hydrochlorothiazide Allergies: none Habits: none Diet: regular Immunizations: up to date Infectious disease exposure: none Physical examination. The following were noted: Vital signs: temperature, 99.4° F; pulse, 80 beats/min; respiratory rate, 16 breaths/min; blood pressure, 130/80 mm Hg General: non-ill-appearing HEENT: nickel-sized ulcer on cheek, slightly raised edges, nonpainful Lungs: normal Heart: normal Abdomen: normal Extremities/skin:…
