A 64-year-old man was referred with an acute ulcer of the left foot. His medical history was remarkable for tachyarrhythmia with atrial fibrillation, high blood pressure treated with fluindione, digoxin and amlodipine, and venous insufficiency most marked on his left leg. He had just spent a two week holiday in the Dominican Republic and nothing particular had happened there. He noticed a non inflamed edema of his left ankle during the flight back. The day after his return an ulcer appeared on the lateral aspect of his left foot, and enlarged rapidly.
Examination on day 8 showed a man in good general health, with no fever. A deep exudative ulcer extending over most of the dorsum of his foot was present, together with inflammatory edema (Fig. 1). The border of the ulcer was raised and bluish red. Neither lymphangitis nor enlarged lymph nodes were noted. Large varicose veins were present on his left limb, with dermite ocre.