SECTION EDITOR: MARY S. STONE, MD; ASSISTANT SECTION EDITORS: SOON BAHRAMI, MD; CARRIE ANN R. CUSACK, MD; SENAIT W. DYSON, MD; MOLLY A. HINSHAW, MD; ARNI K. KRISTJANSSON, MD
The biopsy specimen showed extravasated red blood cells and numerous occluded superficial dermal vessels, some with fibrin thrombi and hyalinization of vessel walls (Figure 2 and Figure 3).
A full hypercoagulation workup was performed and was notable for hyperhomocysteinemia due to a compound heterozygote mutation in the methylenetetrahydrofolate reductase (MTHFR) gene (heterozygous for variants 677C>T and 1298A>C). The workup was otherwise negative for protein C and S deficiencies, antithrombin 3 deficiency, factor V Leiden, and lupus anticoagulant.
Ulcers and Stellate Scars on Bilateral Ankles —Diagnosis. Arch Dermatol. 2012;148(3):385–390. doi:10.1001/archderm.148.3.385-e
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