A 63-year-old female with a history of essential thrombocythemia and hypertension presented with a 4-week history of a worsening ulcer on her right second digit. Initially, the patient attributed the wound to a dog scratch but sought further treatment at an outside clinic when she did not see improvement. She was given a diagnosis of cellulitis and was treated with unknown oral antibiotics and silvadene cream. The ulcer continued to worsen and the patient presented to our hospital. On physical exam, an 8 cm ร 3 cm ulcer was observed on the right second digit. It had violaceous rolled up borders, granulation tissue, fibrinous exudates, and areas of necrotic tissue (Figure 1). The remainder of the physical examination was unremarkable. Initial laboratory values included hemoglobin 12.5 gm/dL, white blood cell count 31.2 K/UL, and platelets 625 gm/dL. An x-ray of the hand showed soft tissue swelling with no evidence of osteomyelitis. The ulcer was evaluated and treated as an infected wound. The patient was started on broad spectrum intravenous antibiotics and underwent excisional debridement with biopsy. Blood and wound cultures were negative for aerobic and anaerobic bacteria, fungi, and acid-fast bacilli. Pathology from the biopsy showed extensive necrosis