title: Recurrent leg ulcers in a young man with hyperhomocysteinemia, factor V Leiden and impaired fibrinolysis.
abstract: We present a young male patient referred to our hospital with leg ulcers on both legs that were more than 3 years refractory to standard treatment with compression therapy. By thrombophilia screening factor V Leiden mutation, hyperhomocysteinemia and evidence for impaired fibrinolysis were found. Treatment with folic acid in combination with long-term oral anticoagulant therapy was added to non-elastic compression therapy. The leg ulcers showed slow improvement and complete healing within 3 years. During a 6-year follow-up period neither new thrombo-embolic events occurred nor recurrence of ulcerations. This case suggests a potential synergistic pathogenic role of factor V Leiden, hyperhomocysteinemia and impaired fibrinolysis in the development of postthrombotic syndrome and his sequelae. We postulate that increased formation of thrombi in the microcirculation of the skin in combination with ambulatory venous hypertension due to recurrent deep venous thrombosis might explain our observation.
authors.affiliation: Department of Dermatology, University Hospital Maastricht, The Netherlands. dkol@sder.azm.nl
authors.forename: D N
authors.initials: DN
authors.lastname: Kolbach
authors.forename: J C J M
authors.initials: JC
authors.lastname: Veraart
authors.forename: K
authors.initials: K
authors.lastname: Hamulyák
authors.forename: L J M
authors.initials: LJ
authors.lastname: Spaapen
authors.forename: H A M
authors.initials: HA
authors.lastname: Neumann
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000328:Adult; D001458:Bandages; D002908:Chronic Disease; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005165:Factor V / Q000032:analysis / Q000235:genetics*; D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005492:Folic Acid / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy; D007871:Leg Ulcer / Q000150:complications / Q000175:diagnosis* / Q000235:genetics / Q000628:therapy; D008297:Male; D010690:Phlebography / Q000379:methods; D012008:Recurrence; D012720:Severity of Illness Index; D019851:Thrombophilia / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy
chemical_list: D000305:Adrenal Cortex Hormones; D005343:Fibrinolytic Agents; C095381:factor V Leiden; D005165:Factor V; D005492:Folic Acid