Cutaneous Leg Ulcer Mimicking Pyoderma Gangrenosum in Patient with Secondary Antiphospholipid Syndrome

Ki-Hoon Hur; Seung-Ki Kwok; Yoon-Jung Park; Jin-Jung Choi; Chul-Soo Cho

doi:10.4078/jkra.2008.15.2.165

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Hur, Kwok, Park, Choi, and Cho: Cutaneous Leg Ulcer Mimicking Pyoderma Gangrenosum in Patient with Secondary Antiphospholipid Syndrome

Original Article

J Korean Rheum Assoc 2008;15(2):165-169.

Published online: 20 June 2008

DOI: https://doi.org/10.4078/jkra.2008.15.2.165

Cutaneous Leg Ulcer Mimicking Pyoderma Gangrenosum in Patient with Secondary Antiphospholipid Syndrome

Ki-Hoon Hur, Seung-Ki Kwok, Yoon-Jung Park, Jin-Jung Choi^∗, Chul-Soo Cho

Division of Rheumatology, St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Division of Rheumatology, CHA Hospital, College of Medicine, Seoul, Korea

^∗Pochon CHA University, Seoul, Korea

Received 16 April 2008 Accepted 30 April 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Antiphospholipid syndrome (APS) is characterized by vascular thrombosis in association with elevated titers of antiphospholipid antibodies. Leg ulcers are a considered to be a cutaneous manifestation of APS due to thrombosis of small to medium sized vessels. We report a case of necrotic non-healing, ankle ulcers mimicking pyoderma gangrenosum associated with APS in 50-year-old man. He had a past history of autoimmune thrombocytopenia and cerebral infarction. Laboratory findings showed a circulating lupus anticoagulant, positive anticardiolipin antibodies as well as anti-dsDNA and anti-Sm antibodies. Skin biopsy of ulcer lesions showed thrombotic vasculopathy of medium sized vessels with minimal leukocyte infiltration. Ulcers were successfully treated with surgical debridement and subsequent skin graft along with anticoagulation therapy.

Keywords: Cutaneous ulceration, Antiphospholipid syndrome, Pyoderma gangrenosum, Systemic lupus erythematosus

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Fig. 1.

Skin ulceration over the right medial malleolus. Multiple ulcers with violaceous overhanging borders and a necrotic edge (A). Fibrinous exudate and granulation tissue on ulcer base after surgical debridement (B).

Fig. 2.

Histopathologic findings of ankle ulcer. The thrombosis of small and medium sized arteries (arrow) and vein (arrow head) was found in the lower dermis and subcutaneous fat tissue. However, infiltration of inflammatory cells was sparse.

Fig. 3.

Ulcer was almost completely healed at two months after skin graft.

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