| Affiliation: | (1) Department of Pathology, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada;(2) Division of Dermatology, Department of Medicine, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada;(3) St. Joseph's Hospital, McMaster University, Hamilton, Ontario, Canada;(4) Division of Plastic Surgery, Department of Surgery, St. Joseph's Health Centre, University of Western Ontario, London, Ontario, Canada;(5) Division of Plastic Surgery, St. Joseph's Health Centre, 268 Grosvenor Street, London, Ontario, N6A 4L6, Canada |
| Abstract: | BackgroundUlceration of the lower extremities is a common disorder that can be very painful. It occurs most frequently in the elderly population as a result of venous hypertension. We report an unusual case of a 32-year-old man with an 11-year history of extensive, painful, bilateral leg ulcers resistant to conventional treatment necessitating above-knee amputation of the left leg. Eventually, the patient was treated with prednisone, which led to almost complete healing of the ulcers of the right leg.ObjectiveThe objective of this report is to discuss a rare cause of chronic bilateral leg ulceration.MethodsDetailed histopathologic examination showed a complex pattern of overlapping features of several specific dermatologic conditions, including necrobiosis lipoidica (NL), necrobiotic xanthogranuloma (NXG), and the destructive form of granuloma annulare (GA).ConclusionThe characteristics of our patient suggest a variant of a cutaneous necrobiotic disorder that has not been previously reported. When clinicians are confronted with recalcitrant ulcerations in the lower extremity, this group of disorders should be considered in the differential diagnosis. |
