Acta Dermato-Venereologica 99-2CompleteContent | Página 36
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QUIZ SECTION
Fast-growing Painful Leg Ulcers in a 26-year-old Woman with Systemic Lupus Erythematosus: A Quiz
Julia HARTMANN, Holger A. HAENSSLE, Alexander H. ENK and Ferdinand TOBERER
Department of Dermatology, Venereology and Allergology, University Medical Center, Ruprecht-Karls-University, Im Neuenheimer Feld 440,
DE-69120 Heidelberg, Germany. E-mail: [email protected]
A 26-year-old woman presented with an 8-month history
of a fast-growing, painful ulceration on her right lower leg
(Fig. 1). The patient’s medical history included systemic
lupus erythematosus (SLE), antiphospholipid syndrome,
arterial hypertension, hypothyreosis and ovarian cysts. One
year previously the patient had had a stroke and Libman-
Sacks endocarditis. Her current medication included 100
mg azathioprine, 5 mg prednisone and 150 mg hydroxy-
chloroquine per day, in addition to rivaroxaban.
Initially, the lesion had presented as a painful bluish
discoloration with no epidermal involvement and had first
been recognized by the patient as a bruise. The patient was
referred to the department of surgery. Sonography and a
magnetic resonance imaging (MRI) of her right lower leg
were performed and the findings were compatible with an
organized haematoma. Therefore the lesion was incised and
drainage was inserted. Following this procedure a second
smaller lesion developed where the drainage had been lo-
cated. As neither lesion healed the patient was referred to
our dermatology outpatient department.
Fig. 1. (a) Lower right leg with 2 partially ulcerated lesions measuring
approximately 3 cm and 6 cm in diameter. (b) Six weeks later the lesions
measured approximately 4 cm and 10 cm in diameter, with a purulent
exudate, slightly undermined borders and livid discoloration of the
perilesional skin.
What is your diagnosis? See next page for answer.
doi: 10.2340/00015555-3044
Acta Derm Venereol 2019; 99: 250–252
This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2019 Acta Dermato-Venereologica.