Abstract
87 year old Caucasian female with chronic painless non-healing ulcers over malleoli was admitted to the hospital. On a physical examination, there were two bilateral and laterally located malleoli ulcers with no discharge. A thorough work up was done: lower extremities venous and arterial Doppler ultrasound did not show any evidence of venous and arterial disease respectively. Heterozygous G20210A Prothrombin gene mutation was found, and the patient was started on anticoagulation. This case reports highlights a possibility of a painless livedoid vasculopathy presentation in a patient without significant past thrombotic events. Therefore, it is important to consider livedoid vasculopathy in the differential in a patient with painless ulcerative, atrophic and/or nodular skin lesions over the shins and malleoli.
Highlights
Livedoid vasculopathy (LV) is an underrecognized vascular disorder of the arterial tree, which can be clinically presented with skin ulceration, nodular changes, ankle edema, and plaques with hyperpigmented borders, known as atrophic blanche
We report a case of G20210A prothrombin gene mutation and painless LV clinically presenting similar to chronic venous insufficiency of the lower extremities
Factor V leiden Protein C/S deficiency Hyperhomocysteinemia plasminogen activator inhibitor (PAI) 4G/4G homozygosity ulcers and secondary skin changes such as atrophic blanche can be the result of another disorder such as chronic venous insufficiency, vasculitis, pyoderma ganrenosum, and so forth [1]
Summary
Livedoid vasculopathy (LV) is an underrecognized vascular disorder of the arterial tree, which can be clinically presented with skin ulceration, nodular changes, ankle edema, and plaques with hyperpigmented borders, known as atrophic blanche. These lesions are painful and are located over the lower shins and ankles [1]. The disease is often incorrectly labeled as vasculitis, whereas, there is no obvious role of inflammation Another important issue that the disease has several conflicting names like livedo vasculitis, livedoid vasculitis, and so forth. We report a case of G20210A prothrombin gene mutation and painless LV clinically presenting similar to chronic venous insufficiency of the lower extremities
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