Zusammenfassung
Beim Antiphospholipidsyndrom treten neben Thrombosen der tiefen Gefäße auch Hautmanifestationen wie Raynaud-Symptomatik, akrale Nekrosen, Petechien, Livedo racemosa, subkutane Knoten und Ulcera crurum auf. Wir berichten über einen 72-jährigen Patienten mit rasch größenprogredientem, schmerzlosem Ulcus cruris. Der Patient war bei bekanntem Vorhofflimmern marcumarisiert. Anamnestisch ließ sich ein Schlaganfall mit passagerer Parese des linken Beines erfragen. Eine Biopsie des Ulkusrandes zeigte histologisch eine lumenstenosierende, verkalkende Arteriosklerose mittelgroßer Arterien. Im Serum konnten Autoantikörper gegen Cardiolipin, β2-Glykoprotein I und Phosphatidylserin nachgewiesen werden, sodass die Diagnose eines Antiphospholipidsyndroms gestellt wurde. Unter einer Therapie mit niedermolekularem Heparin, Dexamethason i.v. und Azathioprin sowie stadiengerechter Lokaltherapie erfolgte innerhalb von 5 Monaten die komplette Abheilung des Ulkus.
Abstract
Antiphospholipid syndrome features not only deep vessel thrombosis but also may have cutaneous manifestations such as Raynaud phenomenon, acral necrosis, livedo reticularis, subcutaneous nodules, and leg ulcers. A 72-year-old man presented with a rapidly progressing leg ulcer. He was already on anticoagulation with warfarin due to atrial fibrillation and disclosed a history of stroke with temporary paresis of the left leg. Histopathology of a biopsy of the edge of the ulcer revealed occlusive arteriosclerosis of medium-sized arteries. Serology showed autoantibodies against cardiolipin, β2- glycoprotein I, and phosphatidylserine which led to the diagnosis of antiphospholipid syndrome. Therapy with low molecular weight heparin, dexamethasone, and azathioprine in combination with stage-adjusted wound care led to complete healing of the ulcer within 5 months.
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Van Beek, N., Schumacher, N., Haase, O. et al. Diagnose eines primären Antiphospholipidsyndroms bei Ulcus cruris unter Marcumar-Therapie. Hautarzt 64, 666–670 (2013). https://doi.org/10.1007/s00105-013-2601-6
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DOI: https://doi.org/10.1007/s00105-013-2601-6