mycophenolic-acid and Leg-Ulcer

Cutaneous polyarteritis nodosa, a special form of polyarteritis nodosa (PAN) without systemic involvement, is classified as one of the ANCA-negative vasculitides of small and medium-sized vessels. It is a very rare disease with unknown etiology and occurs more commonly in women over the age of 40. Typical skin lesions are subcutaneous nodules, livedo racemosa, and ulcerations. We report the case of a 46-year-old woman presenting to our outpatient department who reported having very painful ulcerations of the lower legs with unknown origin for 6 months.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Chronic Disease; Diagnosis, Differential; Female; Humans; Leg Ulcer; Middle Aged; Mycophenolic Acid; Polyarteritis Nodosa; Treatment Outcome

Cutaneous polyarteritis nodosa (CPAN) is a self-limited cutaneous vasculitis characterized by painful nodules, affecting mostly the lower limbs, and livedo reticularis. Despite its benign course, CPAN may display a chronic relapsing evolution with repeated exacerbations. Ulcerative CPAN has a more prolonged evolution and is associated with peripheral neuropathy. We report on a patient with a 20-year history of ulcerative and painful CPAN, refractory to multiple immunosuppressive treatments, treated successfully by mycophenolate mofetil and pentoxifylline.

Topics: Aged; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Leg Ulcer; Mycophenolic Acid; Pentoxifylline; Polyarteritis Nodosa; Skin Diseases, Vascular

A 46-year-old man presented with suberythrodermia and an acral-accentuated sclerosis, which had been progressing over the past 6 months, with extensive, painful ulcers within the sclerotic areas of the calf. Due to acute myelotic leukemia (AML), an allogenic peripheral blood stem-cell transplantation with subsequent immunosupression with mycophenolatmofetil (MMF) and ciclosporin A had been performed 8 years previously. The patient had discontinued treatment on his own after about 2 years, having suffered a cerebroischemic insult in the meantime.. Histological examinations revealed sclerodermatous changes. Titres of antinuclear antibodies were unremarkable. Laser-Doppler-flowmetry also indicated an active inflammatory and sclerosing process. FACS analysis of the peripheral blood did not reveal signs of AML recurrence.. The histological pattern in conjunction with the anamnesis indicated a cutaneous chronic graft-versus-host disease (GvHD). No further organ involvement was observed. The MMF therapy which the patient had discontinued was restarted. In addition, PUVA therapy was initiated. These measures and intensive physiotherapeutic exercises in parallel prevented further progression of the sclerosis and secondary mobility limitations. The ulcers healed completely with pentoxifylline and anti-infective treatment.. After stem-cell transplantation, early diagnosis of GvHD is especially important due to possible irreversible sclerodermatous changes and other organ manifestations. Also for this reason, strict clinical follow-up is especially important with respect to compliance and efficacy of the immunosuppression.

Topics: Anti-Infective Agents; Cyclosporine; Graft vs Host Disease; Humans; Immunosuppressive Agents; Laser-Doppler Flowmetry; Leg Ulcer; Leukemia, Myeloid, Acute; Male; Middle Aged; Mycophenolic Acid; Patient Compliance; Pentoxifylline; Peripheral Blood Stem Cell Transplantation; Physical Therapy Modalities; PUVA Therapy; Scleroderma, Localized; Transplantation, Homologous; Vasodilator Agents