Journal of

Case Reports and Images in Medicine

 
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Case Report
 
Recurrent bilateral lower leg ulcers in an adult patient: A case report
Samuel B. Reynolds1, Blake Shaffer2, Hina A. Sheikh3, Stacey J. Smith4
1Medical Student, Department of Education, Lehigh Valley Health Network, Allentown, PA, USA.
2Resident Physician, Lehigh Valley Health Network, Allentown, PA, USA.
3Co-Chief, Section of Dermatopathology, Pathology and Laboratory Medicine, Anatomic Pathology, Lehigh Valley Health Network, Allentown, PA, USA.
4Internal Medicine and Transitional Year, Residency Program Director, Medicine and General Internal Medicine, Lehigh Valley Health Network, Allentown, PA, USA.

Article ID: 100024Z09SR2016
doi:10.5348/Z09-2016-24-CR-17

Address correspondence to:
Samuel Benjamin Reynolds
3711 Allen Street, Apt 4
Allentown, PA
USA, 18104

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How to cite this article:
Reynolds SB, Shaffer B, Sheikh HA, Smith SJ. Recurrent bilateral lower leg ulcers in an adult patient: A case report. J Case Rep Images Med 2016;2:73–77.


Abstract
Introduction: Adult patients presenting with necrotic leg ulcers at times are often diagnosed and managed for having an infection, which results in unnecessary courses of antibiotics. Early identification and management of pyoderma gangrenosum (PG), consisting, respectively, of a single biopsy with subsequent histopathology and administration of systemic steroids, leads to effective treatment and exploration into its associated conditions.
Case Report: A case of a 58-year-old female presented with a 13-year history of recurrent lower leg ulcers, occurring on either leg and always provoked by minor trauma, which were repeatedly diagnosed and managed as products of bacterial infection. Collaboration with dermatopathology, however, ultimately revealed PG, a disorder of autoimmunity, to be the most likely source of her chronic condition.
Conclusion: Overall, our case exemplifies how maintaining a broad differential and considering all etiologies for necrotic leg ulcers, outside of infection alone, can lead to both more effective management and to the potential discovery of previously undiagnosed autoimmune disease.

Keywords: Gangrenosum, Pathergy, Pyoderma, Ulcer


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Author Contributions
Samuel B. Reynolds – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Blake Shaffer – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Hina A. Sheikh – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Stacey J. Smith – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Samuel B. Reynolds et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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