CASE SYNOPSIS A middle-aged man presented with 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 Medical history: hypertension Medications: hydrochlorothiazide Allergies: none Habits: none Pets: dog Diet: regular Travel: has traveled throughout the Pacific Northwest of the United States Social: divorced; has a son; heterosexual; no recent sexual contact Immunizations: up to date Sports/water exposure: hunting 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,…
