An unusual cause of refractive chronic bilateral leg ulceration.
BACKGROUND
Ulceration of the lower extremities is a common disorder that can be very painful. It occurs most frequently in the elderly population as a result of venous hypertension. We report an unusual case of a 32-year-old man with an 11-year history of extensive, painful, bilateral leg ulcers resistant to conventional treatment necessitating above-knee amputation of the left leg. Eventually, the patient was treated with prednisone, which led to almost complete healing of the ulcers of the right leg.


OBJECTIVE
The objective of this report is to discuss a rare cause of chronic bilateral leg ulceration.


METHODS
Detailed histopathologic examination showed a complex pattern of overlapping features of several specific dermatologic conditions, including necrobiosis lipoidica (NL), necrobiotic xanthogranuloma (NXG), and the destructive form of granuloma annulare (GA).


CONCLUSIONS
The characteristics of our patient suggest a variant of a cutaneous necrobiotic disorder that has not been previously reported. When clinicians are confronted with recalcitrant ulcerations in the lower extremity, this group of disorders should be considered in the differential diagnosis.
Department of Pathology, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada.
Laila M
LM
Sabet
Denise
D
Wexler
Samih
S
Salama
Bing Siang
BS
Gan
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D006801:Humans; D007871:Leg Ulcer / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D008297:Male; D017441:Necrobiotic Disorders / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D011241:Prednisone / Q000627:therapeutic use; D017211:Treatment Failure; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D011241:Prednisone