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Virtual case of the month
Rare necrotic lesion in a pregnant woman
  1. James Wiggins1,
  2. Emily Hayes1,
  3. Marc Heymann2,
  4. Rand Hawari3,
  5. Richard A Carr1
  1. 1 Department of Histopathology, South Warwickshire NHS Foundation Trust, Warwick, UK
  2. 2 Respiratory Medicine, Queen’s Hospital, Romford, UK
  3. 3 Department of Histopathology, Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
  1. Correspondence to Dr Richard A Carr, Warwick Hospital, Department of Histopathology, Warwick CV34 5BW, UK; Richard.Carr{at}

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Clinical question

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 and consider your diagnosis.

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  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, …

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  • Handling editor Iskander Chaudhry.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.