A 49-year-old Algerian woman, was referred for evaluation of cutaneous lesions evolving for four years suggestive of chronic infection. His medical history was relevant for diabetes mellitus diagnosed nine years before, complicated with retinopathy, neuropathy and peripheral vasculopathy secondary to ACTH-secreting pituitary adenoma and controlled after surgery one year before. Her treatment consisted of hydrocortisone and aspirin. On clinical examination, the patient was healthy and afebrile. Hyperkeratotic and pustular cutaneous lesions were present on the second and third digits with onychodystrophy, and progressive extension to the dorsal aspect of the right hand (Fig.
