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ISSN: 1734-1922
Archives of Medical Science
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vol. 13
Letter to the Editor

Successful treatment of a 20-year nonhealing venous leg ulcer in a patient with systemic lupus erythematosus

Cenk Eray Yildiz
Cenk Conkbayir
Halil Erkam Tolgay
Kadir Ceviker
Mustafa Canikoglu
Omer Ali Sayin
Murat Ugurlucan

Arch Med Sci 2017; 13, 3: 691–695
Online publish date: 2017/04/20
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Chronic relapsing ulcerative wounds affecting the lower extremities are frequently associated with venous insufficiency leading to edema. It is a vicious circle unless leg edema is resolved with additional care; otherwise the size and depth of the ulcer as well as symptoms of the patients increase devastatingly [1–3].
Systemic lupus erythematosus is a chronic autoimmune multisystemic, inflammatory disorder without an identified etiology, affecting skin, kidneys, lungs, liver, the nervous system, heart and circulation [4, 5]. Vascular disorders involving the arteries and veins during the course of the disease are common and may lead to significant morbidity and even mortality [6].
Here, we present successful treatment of a leg ulcer, which had existed for over 20 years, in 3 months with a 3-step treatment protocol including treatment of venous reflux, negative pressure wound treatment followed by thrombin-enriched thrombocyte concentrate in a 45-year-old patient with systemic lupus erythematosus.
A 45-year-old male patient was admitted to our institution with a 10 × 12 cm in diameter pretibial leg ulcer. His body surface area was 2.5 m2 and his body mass index was 38 kg/m2. The history revealed being followed irregularly with the diagnosis of systemic lupus erythematosus and use of prednisolone 4 mg daily. The ulcer started 20 years ago after a traffic accident and never healed. He had depressive symptoms such feeling hopeless, irregular and inadequate feeling, and loss of joy of life.
The ulcer was dirty, infected and smelled bad (Figure 1 A). Laboratory work-up indicated increased an erythrocyte sedimentation rate of 103 mm at 1 h (normal: 1–10), C-reactive protein (CRP) of 53 mg/l (normal: 1–10), white blood cell count of 12,000 g/l and 1, 1 and 2 and  levels in protein electrophoresis. Cultures were taken immediately and microscopic evaluation showed Pseudomonas aeruginosa colonization. Ciprofloxacin 750 mg twice daily was initiated according to the antibiogram results.
The nonhealing ulcer was investigated multifactorially. The prednisolone that he had been on for many years was discontinued. An exercise program was started and a protein-rich, low-carbohydrate diet was advised. Lower extremity Doppler ultrasonography revealed grade 4 reflux in the superficial veins of sizes reaching up to 6–10 mm. Further hematologic tests for coagulopathies including protein C and S deficiency, factor 5 Leiden...

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