A 55-year-old man presented with a chronic cheek ulcer. The lesion, which was a reddened nodule measuring 0.5 cm, developed two months before. He was treated with cephalexin, followed by amoxicillin or clavulanate and then with moxifloxacin, but the lesion has not resolved.
It ulcerated slowly, without pain, and the patient was finally referred to the infectious diseases service. History Medical history: Hypertension Medications: Hydrochlorothiazide Allergies: None Habits: None Diet: Regular Immunizations: Up to date Infectious disease exposure: None Sports/water exposure: Hunting Physical examination Temperature: 99.4° F Pulse: 80 beats/min Respiratory rate: 16 breaths/min Blood pressure: 130/80 mmHg Head, eyes, ears, nose, and throat (HEENT): Nickel-sized ulcer on the cheek, slightly raised edges, nonpainful Chest Abdomen: Normal Extremities/skin: Normal Diagnostic evaluation…
