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March> 1, 2008

An Unusual Case of Leg Ulceration—Quiz Case

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Arch Dermatol. 2008;144(3):405-410. doi:10.1001/archderm.144.3.dof70020-a

A 54-year-old man presented with a 2-year history of ulceration of the lower legs and feet. His medical history revealed recurrent venous thromboembolism, factor V Leiden heterozygosity, and monoclonal gammopathy of uncertain significance. There was no arterial disease, and although ultrasonography demonstrated venous insufficiency, compression bandaging had little effect. Physical examination revealed ulceration, purpuric macules, and cyanosis on the lower extremities (Figure 1), which persisted despite wound care and optimal anticoagulation. Results from a vasculitis screening test, including cryoglobulins and anticardiolipin antibody levels, were negative. An amorphous precipitate was present on blood film (Figure 2). A skin biopsy sample was taken from a purpuric macule and stained with hematoxylin-eosin (Figure 3).

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