Necrobiosis Lipoidica Mimicking Chronic Infectious Ulceration: A Case Report and Literature Review

Necrobiosis lipoidica (NL) is a rare, granulating autoimmune disease that can be quite difficult to diagnose. It has a higher incidence in diabetic patients than in the general population. Diagnosis often depends upon both clinical and histopathologic examinations. It has a frequent association with diabetes, metabolic syndrome (obesity, hypertension, high cholesterol), and thyroid diseases. This is the case of a 50-year-old male patient who developed ulcerative skin lesions that were refractory to antibiotic therapy. He underwent antibiotic treatments for about two years, as well as multiple surgical debridement with skin grafting. However, the lesions continued to recur. Finally, after two years, a diagnosis of NL was made. He was subsequently prescribed steroids and immunologics, which improved his symptoms significantly. NL treatment is determined by whether the lesions are ulcerative or not. Typically, management will begin with topical corticosteroids and advance to systemic treatments as indicated. Surgical interventions are generally not recommended, as this disease is known to have pathergy. NL is a rare disease that is difficult to diagnose. It can be mistaken for an infectious etiology, like in our case. Due to the difficulty in diagnosing the disease, treatment can be delayed and, in turn, result in unintended harm to the patient with unnecessary procedures. In the future, there should be further investigation into the pathogenesis of this disease and advancement of diagnostic tools for earlier, accurate diagnosis.