Laboratory investigations demonstrated an increased blood sedimentation rate of 30 mm/h (normal range <20), C-reactive protein of 82.6 mg/l (< 5), 1,334/µl erythrocytes in urine (<15). Serological tests for herpes, tularemia, leptospirosis, and listeriosis were negative. Microbial swabs from the ulcerated lesions remained negative in culture.