Pyoderma-gangraenosum-Like Ulcers Associated with Lupus Anticoagulant

Abstract

A 45-year-old woman presented with a deep ulcerative lesion of the left breast. Two months later, a new cutaneous necrotic lesion located in the right pretibial area was observed. The only serum abnormality was the presence of circulating lupus anticoagulant. Clinical features suggested the diagnosis of pyoderma gangraenosum and histologic examination showed microthrombosis in the dermal capillary vessels adjacent to a dense, mixed inflammatory infiltrate with some degree of vascular damage. Although thrombosis may be the result of vasculitis, it is likely that in our patient the presence of a lupus anticoagulant activity played a role in the pathogenesis of the cutaneous ulcers.

Erythema nodosum associated with antiphospholipid antibodies: a report of three cases

“…15 ± 17 Dermatologic presentations may be the ®rst sign of APS 18 with 40% of patients presenting with skin ®ndings. 19 Livedo reticularis is the most commonly reported aPL-associated dermatologic Erythema nodosum associated with aPL L Nekhlyudov et al condition, 2,4,20 although the antibodies have also been described with necrotizing purpura, 21 pyoderma gangrenosum, 22 cutaneous necrosis, 23 and stasis ulcers of the ankles. 18 APL have also been described with non-in¯ammatory vascular thromboses and vasculitis.…”

Microthrombotic/Microangiopathic Manifestations of the Antiphospholipid Syndrome

“…Additionally, a few case reports have been presented. Grob and Bonerandi [21] presented two SLEassociated APS patients and Selva et al [22] one probably primary APS (PAPS) with LA positivity, in which microthrombosis of the dermal vessels with or without inflammatory infiltrate were found in biopsies of pyoderma gangrenosum. Hughson et al [23] presented the results of a skin biopsy from a PAPS patient with leg ulcers and gangrene of the toes.…”

Miscellaneous conditions

“…Selva et al 71 described a case in which the only evidence of systemic disease was the presence of lupus anticoagulant. In one case the diagnosis was straightforward because the patient had a known underlying disease which predisposed to pyoderma gangrenosum.…”