CASE REPORT
A 65-year-old woman with diabetes mellitus type 2 presented with a
6-week history of verrucous cutaneous plaque of the anterior aspect of
the left wrist. The lesion was painful and ulcerated. The patient denied
any history of trauma or contact with patients with tuberculosis.
Dermatological examination revealed an irregular, erythematous, and
vegetating plaque of the right wrist, measuring 10 x 4 cm, with elevated
and erythematous borders with multiple pustules of different sizes and
central ulceration (figure 1 ). There was no palpable
lymphadenopathy and physical examination was otherwise unremarkable.
Bacterial culture from a pus swab identified Staphylococcus
aureus . Histopathological examination of a skin biopsy specimen showed
acanthosis of the epidermis with inflammatory infiltration of the dermis
made of lymphocytes, neutrophils, plasma cells, and histiocytes. The
search of Leishmania by direct microscopy and polymerase chain reaction
was negative.
The diagnosis of BLP was made. The patient received amoxicillin (3gr
daily) with clavulanic acid (62.5 mg daily) and local wound care for 20
days. Substantial improvement was seen after 6 days (figure 2 ).
A total resolution was obtained and no recurrence was noted after 6
months (figure 3 ).