Secondary ulcer in a 36-year-old cisgender man with HMPX, imaged at lesion day 11.
Located on the right dorsal foot is an 8-mm ulcer with a red base draining scant serosanguinous fluid, rolled edges, and surrounding poorly demarcated, deep red erythema. Part of a secondary crop of lesions, this lesion developed on illness day 8, was mildly pruritic and tender, and was accompanied by the simultaneous onset of numerous similar lesions on the face, scalp, torso, genitals, and bilateral upper extremities. This lesion was scabbed by follow-up at lesion day 20 and had healed with poorly demarcated hyperpigmentation by follow-up at lesion day 27.
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.
There was no history of immunocompromising conditions or medications. This man was on Truvada for HIV pre-exposure prophylaxis.