A 30-year-old woman with HIV, diagnosed 12 years prior and with poor adherence to HIV medication or prophylactic antibiotics for years with CD4 count of 3 and high viral load that is above the quantification range, presented with a large foul-smelling wound on the left inguinal fold (Figure A). She said it started as a “hair bump” on the superficial skin but progressed over the last 10 days to where it is now, a deep wound. Patient denied fevers and chills. Labs were significant for neutropenia and anemia. A punch biopsy of the lesion was performed (Figures B-D).
What is the best diagnosis?
D) Pyoderma gangrenosum