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An Unusual Case of Leg Ulceration—Quiz Case
Sharon M. Crichlow, MB,BS, MRCP;
Sue R. Pavord, MBChB, MRCP, MRCPath;
Neil J. Mortimer, MBChB, BSc(Hon), MRCP;
Herbert Thurston, BSc, MBChB, MD, FRCP;
Karen E. Harman, MA, MB, BChir, MRCP, MD
University Hospitals Leicester (Drs Crichlow, Pavord, Mortimer, and Harman) and Vascular Medicine Group (Dr Thurston), Leicester Royal Infirmary, Leicester, England; and The Skin Centre, Tauranga, New Zealand (Dr Mortimer)
Arch Dermatol. 2008;144(3):405-410.
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REPORT OF A CASE
A 54-year-old man presented with a 2-year history of ulceration of the lower legs and feet. His medical history revealed recurrent venous thromboembolism, factor V Leiden heterozygosity, and monoclonal gammopathy of uncertain significance. There was no arterial disease, and although ultrasonography demonstrated venous insufficiency, compression bandaging had little effect. Physical examination revealed ulceration, purpuric macules, and cyanosis on the lower extremities (Figure 1), which persisted despite wound care and optimal anticoagulation. Results from a vasculitis screening test, including cryoglobulins and anticardiolipin antibody levels, were negative. An amorphous precipitate was present on blood film (Figure 2). A skin biopsy sample was taken from a purpuric macule and stained with hematoxylin-eosin (Figure 3).
Figure appears in full text version.
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Figure appears in full text version.
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