Sallustro Marianna, Marrone Aldo, Florio Anna
University of Naples Federico II, Naples, Italy.
University of Campania "Luigi Vanvitelli", Naples, Italy.
Int J Low Extrem Wounds. 2023 Mar;22(1):190-193. doi: 10.1177/1534734621999029. Epub 2021 Mar 20.
Prevalence of nonhealing ulcers of lower extremities has increased over years causing heavy health, social, and economic burdens. Chronic ulcers are difficult to treat since they require tailored multistep treatment and patient compliance. To treat chronic wounds successfully, clinicians must keep in mind the ulcer etiology as well as the underlying diseases. Several factors may be involved in the pathogenesis of chronic skin ulcers. Leukocytoclastic vasculitis belongs to the group of immune vascular diseases and may be an extrahepatic manifestation of hepatitis C virus (HCV) infection. We describe the case of a patient with a nonhealing vasculitic leg ulcer and chronic HCV infection successfully treated with the combination of advanced dermal substitute and direct-acting antiviral therapy. An 81-year-old female presented to our unit with a 6-month history of a leg ulcer that developed from an exudating skin nodule. At presentation, the lesion was large,caused a severe pain and was unresponsive to analgesics. Skin biopsy showed leukocytoclastic vasculitis. She had a history of old untreated HCV infection, hypertension, type 2 diabetes mellitus, chronic venous insufficiency and tibial arteriopathy. The application of porcine-derived dermal substitute achieved only initial improvement. Therefore, direct-acting antiviral therapy was started, and when HCV RNA became undetectable in blood, pain disappeared and skin ulcer improved up to healing. In conclusion vasculitic leg ulcers can be caused by HCV infection. In such cases, even the use of innovative skin therapy, may obtain only initial and partial improvement, and eradication of HCV viremiais essential to obtain wound healing.
多年来，下肢不愈合溃疡的患病率不断上升，造成了沉重的健康、社会和经济负担。慢性溃疡难以治疗，因为它们需要量身定制的多步骤治疗以及患者的依从性。为了成功治疗慢性伤口，临床医生必须牢记溃疡的病因以及潜在疾病。慢性皮肤溃疡的发病机制可能涉及多个因素。白细胞破碎性血管炎属于免疫性血管疾病，可能是丙型肝炎病毒（HCV）感染的肝外表现。我们描述了一例患有不愈合血管性腿部溃疡和慢性HCV感染的患者，通过先进的皮肤替代物和直接抗病毒治疗相结合而成功治愈的病例。一名81岁女性因腿部溃疡6个月前来我院就诊，该溃疡由一个渗出性皮肤结节发展而来。就诊时，病变较大，引起严重疼痛，对镇痛药无反应。皮肤活检显示白细胞破碎性血管炎。她有既往未治疗的HCV感染、高血压、2型糖尿病、慢性静脉功能不全和胫动脉病变史。应用猪源皮肤替代物仅取得了初步改善。因此，开始直接抗病毒治疗，当血液中HCV RNA检测不到时，疼痛消失，皮肤溃疡改善直至愈合。总之，血管性腿部溃疡可能由HCV感染引起。在这种情况下，即使使用创新的皮肤治疗方法，也可能仅获得初步和部分改善，而根除HCV病毒血症对于伤口愈合至关重要。
