Rare necrotic lesion in a pregnant woman

A 34-year-old female community nurse in her first trimester of pregnancy presented with a 2-week history of a tender, swollen and hyperkeratotic lesion on her chest with no history of trauma. The lesion started as a red ‘spot’, became crusted, pustular and formed an eschar. A generous incisional biopsy was taken. Review the high-quality, interactive digital Aperio slide at http://virtualacp.com/JCPCases/jclinpath-2017-204459 and consider your diagnosis. 1. Anthrax 2. Cowpox 3. Orf 4. Pseudocowpox (Milker’s nodule) 5. Varicella zoster  The correct answer is after the discussion. Histopathology shows superficial ulceration, …