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Published on: March 16, 2022
Large leg ulcers due to autoimmune diseases
Alexander P Rozin1, Dana Egozi, Yehuda Ramon
1B Shine Department of Rheumatology, Rambam Health Care Campus and Rappaport Faculty of Medicine, Technion, Haifa, Israel. a_rozin@rambam.health.gov.il
Summary
Large leg ulcers (LLU) in autoimmune diseases are difficult to treat. Healing often requires a combination of immunosuppressants, antibiotics, and advanced therapies.
Area of Science:
- Rheumatology
- Dermatology
- Vascular Medicine
Background:
- Large leg ulcers (LLU) can complicate autoimmune diseases.
- These ulcers present significant therapeutic challenges and are often treatment-resistant.
Observation:
- Case 1: A 55-year-old woman with mixed connective tissue disease (MCTD) and LLU due to small vessel vasculitis healed with a multi-modal approach including immunosuppressants, vascular support, and local therapies.
- Case 2: A 45-year-old woman with MCTD and LLU, initially unresponsive to various treatments, healed after addressing underlying tibial osteomyelitis and adding cyclosporine.
- Case 3: A 20-year-old man with polyarteritis nodosa (PAN) and LLU due to vasculitis, complicated by sepsis, healed with antibiotics, IVIG, and infliximab.
Findings:
- LLU associated with autoimmune diseases demonstrate extreme resistance to standard therapies.
- Successful LLU healing necessitates a comprehensive, often combined, therapeutic strategy involving immunosuppression, infection control, and advanced wound care.
Implications:
- This case series highlights the complexity of managing LLU in autoimmune conditions.
- Aggressive and individualized treatment plans are crucial for achieving remission in these refractory cases.
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