2009 Southern Regional Meeting Abstracts

Case Report: Livedoid vasculitis(LV) is a vascular disorder mostly affecting females characterized by chronic, recurrent, painful cutaneous shallow ulcerations affecting the lower extremities. Histologic features include hyalinizing vascular changes of the subintimal layer of dermal blood vessels, typically with minimal inflammation.
Literature review revealed a few reported cases of Livedoid vascultis in association with hematological and solid organ malignancies. This report describes a patient who presented with (LV), all possible associated hypercoagulable conditions were ruled out. The leg ulcers did not improve desipte wound care and medical treatment. One year later, the patient was diagnosed with pharyngeal sequamous cell cancer. After one month of chemoradiation, (LV) completely resolved.
A 54 year old a smoker female with pmhx of rheumatoid arthritis presented with a 2wk history of painful ulcers on the dorsum of both legs. She did not notice any weight loss, decreased appetite, fever, leg or Joint swelling or worsening of her arthralgis, or any gaterointestinal,cardiorespiratory or genitourinary symptoms. Temprature:37, Bp: 130/75, HR: 85, no lymph nodes were palpable, respiratory, cardiovascular, abdominopelvic exams were normal.Leg exam showed tender erythematous superfecial ulcers on the dorsum of both legs with no swelling or varicose veins.
Labratory workup revealed a WBC:11, HTC:40, Platlet:345, Cr:1.2 ,Albumin:4.2,normal liver transaminases. RF was Positive,ANA, Anti-ds DNA,Antiphospholipid, anticardiolipin ab, C-ANCA,P-ANCA,HIV ab,HCV ab,HBsag were all negative. Cryoglobuins and homocysteine were undtectable.Factor V leiden and prothrombin G20210A gene mutations were absent.Protein S and C levels were normal. Doppler US of both legs was negative for DVT. Biopsy of the lesions confirmed the diagnosis of Livedoid vasculitis. CT chest, abomen and pelvis were normal. Despite wound care and treatment with pentoxyphilline,dipyridamole, warfarin,steroids,the leg ulcer did not improve.One year later the patient was diagnosed with pharyngeal cancer as a work up of a new left tonsiller mass. After one month of chemoradiation of her cancer, the Livedoid reticularis completely resolved with residual atrophic scars.