Secondary ulcer on the left hand in a 36-year-old cisgender man with HMPX, imaged at lesion day 11.
Overlying the dorsal metacarpophalangeal joint of the left second finger is a tender 5-mm ulcer with a red base, rolled edges, and surrounding erythema.
His illness began as a single pustular lesion on the right fourth finger, followed by systemic symptoms (fever, chills, sweats, fatigue, myalgias, arthralgias, and back pain) on illness day 4. This ulcer imaged here was part of a secondary crop of lesions that developed on illness day 8, which included numerous mildly tender and mildly pruritic lesions on the face, scalp, torso, genitals, and bilateral upper extremities.
There was no history of immunocompromising conditions or medications. This man was on Truvada for HIV pre-exposure prophylaxis.