ALONG CAME A SPIDER . . . . . . CAUSING UNUSUAL ULCERS. N. Correia 1 , R. Abou Jawde 1 , S. Baghdasarian 1 , S. Schmitt 1 ; 1 Cleveland Clinic Foundation, Cleveland, OH (Tracking ID #76813) LEARNING OBJECTIVES: To emphasize the extensive differential diagnosis of lower extremity (LE) ulcers, the incidence of pyoderma gangrenosum (PG) following trauma and the importance of accurate diagnosis, we present a case in which lesions that appeared following a spider bite were intially treated as infection. CASE INFORMATION: A 59 year old man presented with non-healing painful left LE ulcers. He was bitten by a spider after which he noted a small red tender spot over his shin that progressed to an ulcer with purulent drainage. He was treated with oral and intravenous antibiotics, local wound care and surgical debridement without improvement. During treatment he developed a new ulcer on the same leg and an inflamed nodule over the contralateral malleolus. IMPLICATIONS/DISCUSSION: PG, a deforming ulcerative skin disease, usually presents with erythematous nodules or vesiculopustules on the legs. The lesions undergo a rapidly destructive necrotizing process to form large ulcers with surrounding erythema. Although frequently associated with inflammatory bowel disease or immunosuppression, in adults PG can occur spontaneously, following trauma (including spider bites), or in association systemic diseases. Biopsy confirmed the presence of PG in our patient and he improved dramatically on prednisone.