J Korean Rheum Assoc.  2007 Mar;14(1):71-77. 10.4078/jkra.2007.14.1.71.

A Case of Successful Treatments of Venous Leg Ulcers in Secondary Antiphospholipid Syndrome

• Kim BK
• Choi ST
• Son MK
• Lee KH
• Lee SW
• Chung SJ
• Gil JH
• Park YB
• Lee SK

• KMID: 2202193
• DOI: http://doi.org/10.4078/jkra.2007.14.1.71

Abstract

Antiphospholipid syndrome is an autoimmune disorder characterized by recurrent arterial or venous thrombosis, and pregnancy loss. A 57-year-old woman was admitted for aggravation of both leg ulcers. Venogram showed chronic venous obstructions at both lower extremities, and chest x-ray and computed tomography revealed serositis in pericardium and pleura. The laboratory tests revealed pancytopenia, and positive tests for antinuclear antibody, anti-dsDNA antibody, lupus anticoagulant and anticardiolipin antibody, which led to a diagnosis of antiphospholipid syndrome secondary to systemic lupus erythematous. After medical treatments by anticoagulation and immunosuppression, and surgical managements including subtotal skin graft and local flap surgery, leg ulcers had been successfully treated without recurrence. Recognition of antiphospholipid syndrome as a cause of venous ulcer and the treatment plans including anticoagulation and surgical management is important in proper managements.

Keyword

Antiphospholipid syndrome; Venous thrombosis; Leg ulcer; Systemic lupus erythematous

MeSH Terms

Antibodies, Anticardiolipin
Antibodies, Antinuclear
Antiphospholipid Syndrome*
Diagnosis
Female
Humans
Immunosuppression
Leg Ulcer*
Leg*
Lower Extremity
Lupus Coagulation Inhibitor
Middle Aged
Pancytopenia
Pericardium
Pleura
Pregnancy
Recurrence
Serositis
Skin
Thorax
Transplants
Varicose Ulcer
Venous Thrombosis
Antibodies, Anticardiolipin
Antibodies, Antinuclear
Lupus Coagulation Inhibitor

Figure

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  Fig. 1. There was 3 X4 cm sized ulcer at right lower tibia (A), and 2 X3 cm sized ulcer at left malleus area (B).

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  Fig. 2. Distal obstructions of left posterior tibial artery, and right anterior · posterior tibial artery were found in the arteriogram.

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  Fig. 3. Venograms showed chronic obstruction from right infrapopliteal veins to right common femoral vein with superficial collateral vein (A), and multiple obstructions at left tibioperoneal vein (B).

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  Fig. 4. Right ulcer was covered with subtotal skin graft (A), and left ulcer with local adiofascial flap and subtotal skin graft (B).

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