A 72-year-old diabetic woman who was receiving hemodialysis presented with a 10-month history of a nonhealing ulceration on her left leg. For several months, she had received care at a local wound center for presumed stasis dermatitis. Her treatment had consisted of topical steroids; various dressings, including an Unna boot; compression hosiery; and, occasionally, oral antibiotics. Bacterial wound cultures had been positive for Enterobacter cloacae and coagulase-negative staphylococci. The ulcerations had not only persisted, but had also slowly progressed, despite treatment. Prior evaluation also included ultrasonography of the patient's legs, which was negative for deep venous thrombosis, and a cytologic wound smear examination, which was negative for malignant cells.
Schumann K, Hollandsworth K, Ormsby A. Nonhealing Leg Ulceration. Arch Dermatol. 2000;136(10):1263-1268. doi: