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Published on: February 10, 2023
Unilateral lower leg purpura
Satoshi Ogawa1, Masahiro Oka, Makoto Kunisada
1Kobe University Graduate School of Medicine Kobe, Hyogo, Japan.
Dermatology Online Journal
|February 5, 2013
Summary
A purpuric eruption on the leg in a rheumatoid arthritis patient was linked to venous stasis. Increased venous pressure caused erythrocyte extravasation, resolving with hemostatic agents and compression stockings.
Area of Science:
- Dermatology
- Rheumatology
- Vascular Medicine
Background:
- Rheumatoid arthritis (RA) can present with various dermatological manifestations.
- Venous insufficiency is a common comorbidity that can affect the lower extremities.
Observation:
- A 55-year-old woman with RA developed an extensive, unilateral purpuric eruption on her left lower leg.
- The affected leg showed prominent varices and telangiectasia.
- Histopathology revealed perivascular lymphocytic and eosinophilic infiltration with erythrocyte extravasation, but no vasculitis.
Findings:
- The purpuric eruption was attributed to erythrocyte extravasation.
- This extravasation was secondary to increased venous pressure resulting from venous stasis.
- No evidence of primary vasculitis was found.
Implications:
- This case highlights a potential mechanism for purpuric eruptions in RA patients with venous insufficiency.
- Management focusing on venous pressure reduction (hemostatic agents, compression stockings) can be effective.
- Understanding the interplay between RA, venous stasis, and purpura is crucial for accurate diagnosis and treatment.
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