How do you explain this ulcerative abdominal rash?

Case 4:
This abdominal rash developed while a 63-year-old woman was traveling in Israel. She was admitted to the hospital, where she received intravenous antibiotics, and was discharged after 5 days. She now returns to the United States and wonders what she had, because she did not understand what the physician in Israel had told her. She has brought all of her medical records.

Before you review the records, what do you suspect on the basis of the physical findings?

A. Panniculitis.
B. Staphylococcal infection.
C. Streptococcal infection.
D. Pseudomonas infection.
E. Leishmaniasis.

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The physical findings suggested ecthyma, which was consistent with the culture results that revealed group B streptococci, C. The patient was most likely at risk for the infection because of her obesity. Fortunately, she recovered uneventfully.

Pseudomonas ecthyma is usually a more aggressive disease that spreads hematogenously and carries a poor prognosis. Staphylococcal infection and leishmaniasis generally do not present this way. Panniculitis is not typically accompanied by skin ulcerations.