A 30-year-old man presented to the emergency department with a left leg wound that had been present for five years and “worsening over the past four months.” The patient presented because he was on the verge of losing his job because of the odor from the wound. The patient described the lesion as painful, making it difficult to ambulate. He denied recent trauma to the area. However, he had a remote history of a car accident years ago but didn’t remember any injury to the leg. He reported subjective fevers, nausea, and vomiting over the past few weeks. His past medical history was significant for smoking and nephrotic syndrome. No family history of autoimmune disorders was reported, and he denied any prior dermatological conditions.
Upon entering the patient’s room, an intense, putrid odor was noted. The patient appeared in no acute distress, and his vital signs were normal. The patient had large ulcers with undermined borders and erythematous edges on the entire aspect of his left lateral and medial leg (see Figures 1 and 2). The leg was diffusely tender to palpation, with distal strength and sensation intact. No edema was noted. Dorsalis pedis and posterior tibial pulses were intact.