Patient of Dr 

74 year old female presented feeling a little bit unwell with new spot on her lip. On further questioning she also had a new lesion on her pubis as well.
Her past medical history was significant for Rheumatoid Arthritis (for which she is on Hydroxychloroquine, Methotrexate, Prednisone and 6 monthly Rituximab), she is also a type II diabetic on oral hypoglycaemic medication!
When I saw her originally she was only vaguely unwell, but given the lesion on her upper lip I rang an infectious diseases consultant to discuss the possibility of cutaneous anthrax, organised bloods to be done, and took swabs.
Her CRP was 132, and the ulcer on her upper lip swabbed positive for both pseudomonas and HSV I, and I asked her to present to hospital immediately. In hospital they swabbed the lesion on the pubis as it progressed to an ulcer and it grew pseudomonas as well. Blood cultures were negative.
For this ecthyma she was treated under the infectious diseases team as in inpatient with 5 days of IV antibiotics and antivirals, her methotrexate was withheld and the lesions gradually resolved.