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 ).