Successful Use of Hyperbaric Oxygen as Adjunctive Therapy for a Nonhealing Venous Ulcer in a Patient with Systemic Sclerosis and Pulmonary Arterial Hypertension: A Case Report and Review of the Literature.

Isaac Biney,Tina Dudney,Elise Schriver,Lee Carder,Mitchell Goldman

doi:10.1155/2020/4750375

Isaac Biney, Tina Dudney + Show 3 more

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https://doi.org/10.1155/2020/4750375

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Abstract

Skin ulcers are a common complication of systemic sclerosis (SSc) that can significantly impact the quality of life. There have been recent reports on the use of hyperbaric oxygen therapy (HBO2T) in the management of nonhealing systemic sclerosis skin ulcers. The effect of HBO2T on pulmonary arterial hypertension (PAH), another common and potentially life-threatening complication of SSc, is unclear with literature on the subject lacking. We present the case of a 65-year-old female with limited SSc complicated by severe PAH and a nonhealing left lower extremity venous ulcer. HBO2T was successfully used as an adjunct in her management resulting in complete resolution of the venous ulcer and improved quality of life without any adverse effects on her pulmonary arterial hypertension.

Highlights

Systemic sclerosis (SSc) is a chronic connective tissue disease with multiorgan involvement characterized by diffuse microangiopathy and the deposition of collagen into the skin and internal organs leading to progressive fibrosis
We report a case of successful use of HBO2T as adjunctive therapy for the treatment of a nonhealing venous ulcer in a patient with limited SSc complicated by pulmonary arterial hypertension (PAH)
Though our patient had a venous ulcer, similar challenges can be encountered in a patient with SSc as the disease has been associated with poor wound healing on account of the vasculopathy

Summary

Introduction

Systemic sclerosis (SSc) is a chronic connective tissue disease with multiorgan involvement characterized by diffuse microangiopathy and the deposition of collagen into the skin and internal organs leading to progressive fibrosis. Vascular impairment may cause nonhealing of ulcers arising due to other mechanisms These ulcers can be very painful and can cause a significant decline in a patient’s quality of life. There have been several case reports of successful use of HBO2T in nonhealing ulcers, involving both the digits and extremities, in patients with SSc [4,5,6]. We report a case of successful use of HBO2T as adjunctive therapy for the treatment of a nonhealing venous ulcer in a patient with limited SSc complicated by PAH

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