PMC9341257_01
Clinical manifestations at the time of initial presentation. (A) An ulcer and patchy erythema around it on the inner lower third of the right leg, blue tattoos were nearby; (B) an ulcer and flaky dry erythema around it on the right side of the loin, blue Chinese tattoos were nearby. The tattoos have been blurred as patient's privacy.
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Physical examination revealed a 0.8x1.8 cm ulcer on the inner lower third of the right leg, with small amount of yellow exudate on the ulcer base, large patchy erythema with edema around the ulcer, and blue tattoos near the ulcer (Figure 1A). Another 1.5x2.0 cm ulcer, with a deep surface and regular margin, was seen on the right side of the loin, and large flaky dry desquamation erythema surrounding the ulcer, blue Chinese character tattoos were nearby (Figure 1B).
Hyperkeratosis with some part of parakeratosis (black arrow), and spinous hypertrophy (blue arrow) in the dermis (A) (H&E, 40x, scale bar: 100 um). Numerous eosinophils (blue arrow), dense lymphocytes (white arrow), some histiocytes (red arrow) and neutrophils (black arrow) infiltrated the dermis (B) (H&E, 100x, scale bar: 40 um).
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Histopathological examination of the ulcer of the right leg showed epidermal hyperkeratosis with incomplete keratosis, the stratum spinosum was hypertrophic (Figure 2A), the dermis was permeated with dense lymphocytes and numerous eosinophils infiltrated, some histiocytes and neutrophils were also seen (Figure 2B), no obvious inflammatory cell infiltration was observed in subcutaneous tissue.
Clinical manifestations after systemic anti-inflammatory therapy. The ulcers and surrounding lesions on the leg (A) and the loin (B) had resolved. The tattoos have been blurred as patient's privacy.
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One month later, ulcers were completely healed, and the erythema around the ulcer subsided, leaving only pigmentation (Figure 3A and B).