Non-healing wounds in older patients can have multiple causes, including infection, inflammatory disease and malignancy. Diagnostic uncertainty can delay appropriate treatment.

Leprosy and American cutaneous leishmaniasis are endemic diseases in Brazil that may coexist in the same host, particularly in coendemic regions. We report the case of a 68-year-old woman presenting with a six-month history of an ulcerated lesion on the left knee and concomitant disseminated annular plaques associated with sensory loss, madarosis, and peripheral nerve thickening. Histopathological examination of the ulcer demonstrated findings compatible with cutaneous leishmaniasis; immunohistochemistry using CD1a highlighted structures compatible with amastigotes, acknowledging its limitations. Biopsy of the plaques revealed a chronic granulomatous dermatitis with numerous acid-fast bacilli, corroborating multibacillary leprosy in the appropriate clinical context. The patient was treated with multidrug therapy for leprosy and intralesional meglumine antimoniate for leishmaniasis, with favorable outcomes. To the best of our knowledge, this is the first published report of such coinfection in Ceará. This case highlights the importance of sampling lesions with distinct morphologies and integrating clinical, histopathological, and laboratory findings in endemic settings.

The renin-angiotensin system (RAS), a pivotal target in gastric ulcers, has been shown to regulate ferroptosis in bronchial epithelial cells. Rosmarinic acid (RA) possesses significant anti-ulcer and anti-ferroptosis effects. However, it is still unclear whether RA alleviates gastric ulcers by preventing ferroptosis.

ObjectiveTo evaluate the clinical severity and microbiological characteristics of participants with type 2 diabetes and foot ulcers (DFUs) screened for eligibility into a bacteriophage therapy pilot study.Research Design And MethodsAdults aged (≥18 years) with type 2 diabetes mellitus (T2DM) and active DFUs presenting to a tertiary care centre were screened using predefined eligibility criteria. Ulcers were graded according to the University of Texas Diabetic Foot Classification System. Microbiological analysis included standard culture techniques and biochemical tests for identification of microorganism. Descriptive statistics were used to summarize ulcer severity, microbial patterns, and eligibility outcomes.ResultsA total of 595 individuals were screened. Grade 3 ulcers accounted for 51.1% of cases, followed by Grade 2 (29.1%) and Grade 1 (19.8%). Monomicrobial infections were identified in 63.7% of individuals, polymicrobial infections in 17.6%, and no growth in 18.7%. Gram-negative organisms predominated, including Pseudomonas spp. (n = 74), Escherichia spp. (n = 60), Klebsiella spp. (n = 50), Proteus spp. (n = 43), and Acinetobacter spp. (n = 25). Among Gram-positive organisms, Staphylococcus spp. (n = 81) and Enterococcus spp. (n = 43) were common.ConclusionsThe screened population demonstrated a high burden of advanced Grade 3B DFUs, predominantly associated with Gram-negative pathogens amenable to bacteriophage targeting. But this pilot study intentionally focused on Grade 1B and Grade 2B ulcers to assess the feasibility and safety of bacteriophage therapy in predefined, less severe DFUs. This pre-screening process supported the feasibility and enrollment of eligible participants for the subsequent bacteriophage therapy pilot study.

Keratinocyte cancers (KCs) are increasing in incidence in the UK, with over 234 000 cases annually, largely due to demographic changes and sun exposure. Skin cancers, including malignant melanoma and KCs, are projected to cost the NHS over £180 million annually and impose healthcare demands. Although KCs have high cure rates following surgical excision and primary closure, wounds healing by secondary intention (HBSI) particularly on the lower leg present clinical challenges. Compression therapy (CT) known to improve venous insufficiency and venous ulcer healing may also benefit HBSI following lower limb KC excision but current evidence is sparse.