Case History/Examination
A 70-year-old female with diabetes and heart failure presented with asymptomatic plaques and nodules on her left hand over six months, treated unsuccessfully with oral steroids and antibiotics. Physical examination revealed three cauliflower-like hyperkeratotic nodules with secondary ulcerations and pustules on the left forearm, without lymphadenopathy (Fig. 1 – a, b). The patient denied any insect bites, occupational exposure, or travel history, but reported spending time gardening.
Methods