Stasis Ulcer and Its Possible Etiologies

A 62-year-old female, a known case of hypothyroidism, diabetes mellitus, and varicose veins, presented with a complaint of swelling of both lower limbs and ulceration on the left leg for 2 months. She also complained of dyspnea on exertion. As per the history, ulcer began as a pea-sized blackish discoloration on the left lower limb just above the ankle joint on medial aspect (Fig. 1) and increased to 6 × 8 cm, with irregular and raised margins (Fig. 2). The base of ulcer had whitish-yellow exudate with no healthy granulation tissue. The surrounding skin revealed hyperpigmentation. On examination, she had bilateral lower limb pitting edema-grade IV (Fig. 3), extending from above ankle to mid-calf region. The skin appeared to be shiny. Investigations revealed microcytic hypochromic anemia and high fructosamine levels. There was no history of trauma. Anti-HIV was negative. A biopsy was taken, thus revealing it to be a stasis ulcer. Our initial assessment for the causes of this ulcer included anemia resulting in poor perfusion, venous insufficiency exacerbated by varicose veins, and hypothyroidism or diabetes mellitus contributing to poor wound healing.