Back issues No.1 - 2013 / Resident Forum  

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Recurrent ulcers on a hypertrophic lower extremity since childhood
Kuei-Chung Liu, Chao-Chun Yang

A 68-year-old woman with underlying hypertension came to our clinic for a progressively enlarging ulcer (10.5 × 6 cm) with occasionally active and projectile bleeding on her right dorsal foot for 5 months. The ulcer recurred several times on the same area since teenager years and resulted in indurated and fibrotic skin. Her right lower extremity became progressively hypertrophic with the presence of varicose veins since her childhood. At the time of her visit to our clinic, there were prominent varicose veins, port wine stains, and local warmth on the hypertrophic leg without thrills or bruits (Figure 1). The physical examination was otherwise normal. Laboratory examination revealed no thrombocytopenia or anemia. Bacterial isolation from the wound showed moderate growth of Pseudomonas aeruginosa, Klebsiella pneumoniae, and Staphylococcus aureus. Skin biopsy at the edge of the ulcer revealed extensive dermal sclerosis with deep ulceration and features of venous stasis and lymphedema. Image study by dynamic contrast-enhanced, multiphased magnetic resonance angiography of bilateral lower extremities showed increased vasculature with high-flow vascular lesions at the subcutaneous regions and muscles (Figure 2). Hypertrophy of the subcutaneous tissue and fibrous septa between muscle groups over the right leg and foot was also demonstrated.

Parkes Weber syndrome.

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