Question: Can you identify this condition?

A 45-year-old aboriginal woman with a 30-year history of debilitating rheumatoid arthritis presents with an ulcer on her right foot. She initially developed this ulcer 3 years ago following a traumatic incident. The ulcer is very painful and has not responded to multiple courses of antibiotics and different dressings. She is currently taking acetaminophen and short-acting morphine. She is also taking 5 mg of prednisone per day for her rheumatoid arthritis.

The most likely diagnosis is

1. Arterial ulcer

2. Varicose ulcer

3. Wegener granulomatosis

4. Pyoderma gangrenosum

5. Clostridium spp infection

Answer on page 379

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