A 73-year-old man presented 2 weeks after bilateral total knee arthroplasty with painful ulcerative lesions on bilateral surgical sites. The patient first noticed erythema around the incisions 1 week after surgery, which was followed by the development of ulcerations. These lesions progressed despite wound care and a course of oral doxycycline. On examination, both knees had ulcerative lesions with violaceous undermined borders (Figure 1). The radiograph showed well-fixed prosthesis. Synovial fluid analysis showed cell count of 3342 cells/uL with 42% neutrophils and 3035 with 53% neutrophils from the right and left knee, respectively, and cultures remained negative.
