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A Prickly Situation

      A 55-year-old man with HIV and hepatitis C infections presented to our emergency department with a fever and a 7×4-cm bleeding ulcer of the right forearm. The patient had a history of heroin and cocaine use by injection, and he had been injecting the drugs into the ulcer. On admission, examination revealed a 2×2-cm pulsatile vessel at the center of the right forearm wound (Figure 1). Ulnar and radial pulses were palpable distal to the pulsatile vessel, and sensorimotor function of the right hand was intact.
      Figure thumbnail gr1
      Figure 1A 2 × 2-cm pulsatile vessel is visible at the center of the right forearm wound.
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