Case 7-1991

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Abstract
Presentation of CaseA 21-year-old woman was admitted to the hospital because of a persistent rash on her elbow.The patient was well until five weeks earlier, shortly before the end of a six-month stay in Costa Rica, when she became aware of a skin lesion on the right elbow. One day after her return to Massachusetts she consulted her physician. Physical examination showed a localized rash (Fig. 1 and 2), 5 or 6 cm, on a crusted extensor surface of the elbow; a shallow ulcerated area in the center was irregularly rounded and had raised margins; several discrete satellite lesions . . .