What if? | Figure 1

Sperra

Infectious Diseases Resident

Woman, 48 years old diabetic in insulin treatment. Chronic renal failure in pre-haemodialysis. She was sent to our unit from a dermatologist. She refers to had some similar lesions on the same leg several years before but the lesions were smaller and deeper and got solved with hyperbaric therapy. She refers that the lesions began as a solid not painful nodule that slowly expanded as in the pictures after being bitten by something (maybe a mosquito) while she was walking in a rural road with her dog. She made a course of doxycycline without benefit (she made also a cycle of amoxicillin/clavulanate a month before). We made a skin biopsy in suspected cutaneous leishmania with a negative result. An infiltrate of lymphocytes and eosinophil was described. Blood values in range with just a small raise of CRP. Any idea from your experiences? Thank you!

The author made an update to this case

Update 1

I want to thanks all of you for helping us to solve the case. We asked our dermatologist for another cutaneous biopsy with a positive result for necrobiosi lipoidica. Thanks again to all.
Best regards
S.P

Diagnosis Added

Diagnosis: Necrobiosi Lipoidica