A rare cause of cutaneous ulceration: Prolidase deficiency Dear Editors, Prolidase deficiency (PD) is a rare hereditary disease characterised by skin lesions including ulcerations, frequent infections, characteristic facies, mental retardation, and splenomegaly. Diagnosis of prolidase activity is made by sequence analysis of the peptidase D (PEPD) gene in erythrocytes, leukocytes, or fibroblasts. 1 Here, we report a case with associating immunological abnormalities and PD.A 20-year-old boy was admitted to the dermatology clinic for severe ulceration on lower extremities, which were persistent for the past 6 months. Family history indicated that his parents were first-degree relatives. On dermatological examination, there were several geographic ulcers on the thighs and soles with irregular borders (Figures 1 and 2). Atrophic depressed scars on the cheeks were also noted. Laboratory studies showed an elevated erythrocyte sedimentation rate (31 mm/h), elevated IgG level (2100 mg/dL; 750-1560 mg/dL), and elevated total IgE level (379 UI/mL; 1.3-165 UI/mL). Antinuclear antibodies (ANA) were positive at a titre of 1:320 (homogenous and granular pattern). Complement components (C3-C4) were within normal levels, and antibodies to double-stranded DNA, cardiolipin, rheumatoid factor, cryoprotein precipitates, and direct Coombs test were negative. Abdominal ultrasonography showed splenomegaly with a 16 cm vertical length of spleen. Multiple skin biopsies from the edge of the ulcers demonstrated thrombus formation, fibrin, and perivascular
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