Persistent cutaneous abdominal ulcerations secondary to diffuse dermal angiomatosis

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.

Multifocal Diffuse Dermal Angiomatosis: A Reflection of High Cardiovascular Risk

“…After excluding cases with explicit unifocal involvement, involvement of both breasts, or un-reported location, 13 cases were found in the literature of DDA with multifocal involvement (1,(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14), as in our case (Table SI 1 ). Among them, 84.6% involved women, with mean age 58 years; 46.2% involved current smokers; and 46.2% featured atherosclerosis, as expected according to the review of Touloei et al (3) The thigh was the most common location, observed in 61.5% of cases.…”

“…According to the literature data, topical corticosteroids did not show to be an effective option for the treatment of DDA, explaining why we did not prescribe them despite the fact that the abdominal lesions had previously developed favourably with topical corticosteroids. The efficacy of revascularization of the involved area ( 1 , 3 , 4 , 7 , 10 , 14 ) has been reported and seems to be the most efficient treatment with extremities involvement.…”

“…This hypothesis is supported by 5 cases of haemodialysis-related arteriovenous fistula with DDA occurring on the same upper extremities (3), a case of prior breast reduction in the same location as DDA (4), and by the current case, after surgery of the abdominal wall. An ischaemic mechanism is also supported by some patients with an underlying arterial occlusion or tight artery stenosis of the leg or thigh and DDA in the same location (1,4,7,8,10,13,14).…”

Diffuse dermal angiomatosis of the breast

“…Lesions tend to persist and progressively enlarge. [5][6][7][8] While the extremities are the most commonly reported location, there have been several reported cases of DDA of the breast (DDAB), indicating that DDAB is likely more prevalent than previously thought. 5,[9][10][11][12][13] Herein, we report a case of bilateral DDAB and review the management strategies utilized for this disease to date.…”

Chronic eczema in a patient with type 2 diabetes mellitus associated with infection caused by Klebsiella spp.

“…В клинической практике известны различные поражения, обусловленные клебсиеллами. Так, при ангиоматозе кожи со вторичными кишечными изъязвлениями у 63-летней пациентки была обнаружена Klebsiella pneumoniae [12]. Данный возбудитель нередко обладает резистентностью ко многим лекарственным препаратам (РМЛП).…”