Abstract
Necrotic facial lesions can have variable presentations, including presenting as a secondary infection. We present a case of a progressively enlarging necrotic facial lesion in an HIV-positive patient. The patient reported the lesion began five months earlier after a presumed brown recluse spider bite. Despite initial debridement at another hospital, the wound continued to worsen, developing purulent and bloody discharge, escalating pain, and systemic symptoms. On examination, a fungating necrotic mass involving the right face was noted. Imaging suggested possible bony involvement, and biopsy confirmed poorly differentiated squamous cell carcinoma. This case highlights the diagnostic complexity of differentiating between chronic infectious processes and malignancy in immunocompromised patients. The patient's lack of HIV treatment and unstable living situation contributed to delayed care and advanced disease. Early dermatologic evaluation and biopsy of non-healing lesions are critical, particularly in populations facing medical and social vulnerabilities.