| Summary: | Aim: Highlighting the diagnostic complexity of skin ulcers. Method: We present a 31-year-old female patient who came to the ulcer unit of "Andreas Syggros" Hospital suffering from a festering necrotic ulcer that appeared a year earlier. She provided a previous punch biopsy result which was compatible with pyoderma gangrenosum. In accordance with the diagnosis, she was already treated with steroids, colchicine, and multiple antibiotics due to positive cultures for E. coli and Pseudomonas aeruginosa. These treatments had little or no response. Due to the atypical clinical presentation of a persistent ulcer and the later appearance of systemic symptoms, we proceeded to do a surgical wedge biopsy and an immunohistochemistry examination. Results / Discussion: The new biopsy was compatible with a diagnosis of T-cell non-Hodgkin lymphoma (ALK+ large cell lymphoma). Conclusion: In some cases, a punch biopsy may lead to a misdiagnosis, so it is useful to perform a surgical wedge biopsy. Physicians should therefore be alert when a skin lesion persists, because it may indicate the presence of a serious underlying systemic disease.
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