title: Persistent cutaneous abdominal ulcerations secondary to diffuse dermal angiomatosis: an underestimated sign for severe atherosclerosis: A case report.
abstract: BACKGROUND
  Diffuse dermal angiomatosis (DDA) is a rare, acquired, reactive vascular proliferation, clinically characterized by livedoid erythematous-violaceous plaques, which frequently evolve to ulceration and necrosis. Histopathologically, it is manifested by a diffuse proliferation of endothelial cells within the full thickness of the dermis. DDA has been mainly associated with severe peripheral atherosclerosis.
  
  
  METHODS
  We report a 63-year-old woman who presented with multiple erythematous-violaceous plaques with central deep skin ulcers on thighs, lower abdomen, and perianal area, associated with intermittent claudication, low-grade fever, and weight loss. Initially, the clinical picture along with positive cultures for Klebsiella pneumoniae suggested a multifocal ecthyma gangrenosum; nevertheless, a skin biopsy showed a diffuse dermal proliferation of endothelial cells interstitially arranged between collagen bundles. A computed tomography scan revealed severe aortic atheromatosis with complete luminal occlusion of the infrarenal aorta and common iliac arteries.
  
  
  RESULTS
  The diagnosis of DDA secondary to severe atherosclerosis was established. The patient underwent a left axillofemoral bypass surgery with a rapidly healing of the ulcers in the next weeks.
  
  
  CONCLUSIONS
  DDA should be considered in the differential diagnosis of livedoid ischemic lesions. Recognition of DDA as a cutaneous sign of severe peripheral vascular disease is important for both dermatologists and internists. Recognition of risk factors and their management with an early intervention to correct tissue ischemia can be curative.
authors.affiliation: Department of Dermatology Department of Vascular Surgery Department of Pathology Department of Infectious Diseases, Hospital del Mar, Parc de Salut Mar, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Lidia
authors.initials: L
authors.lastname: García-Colmenero
authors.forename: Gemma
authors.initials: G
authors.lastname: Martin-Ezquerra
authors.forename: Ignacio
authors.initials: I
authors.lastname: Gómez-Martín
authors.forename: Meritxell
authors.initials: M
authors.lastname: Mellado Joan
authors.forename: Carlos
authors.initials: C
authors.lastname: Barranco
authors.forename: Raquel
authors.initials: R
authors.lastname: Albero-González
authors.forename: Judith
authors.initials: J
authors.lastname: Villar-García
authors.forename: Ramon M
authors.initials: RM
authors.lastname: Pujol
mesh_terms: D000798:Angiomatosis / Q000175:diagnosis* / Q000209:etiology*; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D001706:Biopsy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D012883:Skin Ulcer / Q000175:diagnosis* / Q000209:etiology*; D014057:Tomography, X-Ray Computed