Shatnawi Nawaf J, Al-Zoubi Nabil A, Al-Bakkar Lujain A, Gharaibeh Laith M, Hamouri Shadi
Jordan University of Science and Technology, Irbid, Jordan.
Int J Low Extrem Wounds. 2023 Dec;22(4):742-747. doi: 10.1177/15347346211037850. Epub 2021 Aug 10.
Chronic leg ulcers (CLUs) are common, with increasing prevalence in the elderly population. Circulatory dysfunctions are responsible for 90% to 95% of all causes, while 5% to 10% of CLUs are associated with underlying chronic systemic disorders. Sarcoidosis is a complex multisystemic disease characterized by noncaseating granulomas affecting mainly the pulmonary system, with cutaneous manifestation in 25% to 30% of cases. However, ulcerative sarcoidosis (US) is a rare form of cutaneous sarcoidosis. Pyoderma gangrenosum (PG) is an uncommon, chronic inflammatory noninfectious skin disease affecting different body parts. The ulcerative form of PG is rarely reported in association with sarcoidosis.We aim to report a 44-year-old female patient with a history of hypertension and varicose veins, presenting with a CLU for more than 18 months. Ulcer tissue biopsy showed noncaseating granuloma with abscess formation suggestive of sarcoidosis; however, PG could not be ruled out. Mediastinal lymph node biopsy was consistent with sarcoidosis. The leg ulcer had complete healing within 4 months by local wound management, negative pressure wound therapy, and split-thickness skin grafting without immunosuppressive treatment to achieve wound healing.
慢性腿部溃疡（CLU）很常见，在老年人群中的患病率呈上升趋势。循环功能障碍是所有病因的90%至95%，而5%至10%的CLU与潜在的慢性全身性疾病有关。结节病是一种复杂的多系统疾病，其特征是非干酪样肉芽肿，主要影响肺部系统，25%至30%的病例有皮肤表现。然而，溃疡性结节病（US）是皮肤结节病的一种罕见形式。坏疽性脓皮病（PG）是一种罕见的、慢性炎症性非感染性皮肤病，可累及身体不同部位。PG的溃疡性形式很少与结节病相关报道。我们旨在报告一名44岁女性患者，有高血压和静脉曲张病史，出现CLU超过18个月。溃疡组织活检显示非干酪样肉芽肿伴脓肿形成，提示结节病；然而，不能排除PG。纵隔淋巴结活检与结节病一致。通过局部伤口处理、负压伤口治疗和断层皮片移植，在4个月内腿部溃疡完全愈合，无需免疫抑制治疗即可实现伤口愈合。
