Objective: We report the case of a leg ulcer in a rheumatoid arthritis (RA) patient under treatment with leflunomide, discuss the influence of the drug on the aetiopathogenesis of the ulcer and describe its successful...Objective: We report the case of a leg ulcer in a rheumatoid arthritis (RA) patient under treatment with leflunomide, discuss the influence of the drug on the aetiopathogenesis of the ulcer and describe its successful treatment. Case summary: A 68- year- old woman with a 12- year history of RA developed a leg ulcer after 4 months of leflunomide treatment. Other ulcerogenic factors were ruled out. There were some clinical hints for rheumatoid vasculitis. The ulcer was resistant to ambulant conservative phase adapted wound bed preparation and a split skin transplantation failed. After omission of leflunomide and washout procedure with cholestyramine a second split skin transplantation resulted in complete healing. Discussion: Leflunomide inhibits the division of activated T cells and thus inhibits among others the production of proinflammatory cytokines and the adhesion of cells to the endothelium. These mechanisms may partly explain the possible influence of leflunomide on the perpetuation of the ulcer. Until now, occurrence of vasculitis and leg ulcers has been described in one case each for the novel immunomodulator leflunomide. No successful treatment of a leg ulcer under leflunomide has been described yet. Omission of leflunomide and a washout treatment in our case led to a complete healing. This may indicate a critical role of leflunomide in the maintenance of this slow healing ulcer. Conclusions: An association between leflunomide intake, occurrence of leg ulcers in RA patients and delayed wound healing should be considered.展开更多
Klinefelter’ s syndrome is the most frequent major abnormality of sexual differentiation in men with two or more X chromosomes. Recurrent venous ulcers as a result of a post- thrombotic syndrome are a well known symp...Klinefelter’ s syndrome is the most frequent major abnormality of sexual differentiation in men with two or more X chromosomes. Recurrent venous ulcers as a result of a post- thrombotic syndrome are a well known symptom in patients with Klinefelter’ s syndrome. Until now the underlying pathomechanisms are not completely understood. Platelethyperaggregability,factor V Leiden mutation and abnormalities in fibrinolysis were implicated as possible contributing factors. Here we describe the detection of an increased activity of factor VIII coagulant (factor VIII: C). This is the first case report on increased factor VIII: C activity associated with venous ulcers in a patient with Klinefelter’ s syndrome. Elevated factor VIII plasma levels are gradually accepted to be associated with an increased risk for venous thromboembolism. Therefore, we discuss that the examination of factor VIll: C may help in clarifying individual thromboembolic risks, especially in patients with Klinefelter’ s syndrome.展开更多
Linear IgA dermatosis (LAD) is a well-recognized acquired subepidermal bullous autoimmune disease. LAD is characterized by clinical, histopathological and immunopathological findings. We report the case of a 38-year-o...Linear IgA dermatosis (LAD) is a well-recognized acquired subepidermal bullous autoimmune disease. LAD is characterized by clinical, histopathological and immunopathological findings. We report the case of a 38-year-old man who suffered from a chronic myeloic leukaemia. Although he received immunosuppressive therapy he developed LAD after an allogenic bone marrow transplantation. After diagnosis of LAD was establishedwestartedasuccessfulsystemictherapywithdapsone, while continuing the preliminary medication. Here we report for the first time on a possible relationship between LAD and bone marrow transplantation in an immunosuppressed patient.展开更多
文摘Objective: We report the case of a leg ulcer in a rheumatoid arthritis (RA) patient under treatment with leflunomide, discuss the influence of the drug on the aetiopathogenesis of the ulcer and describe its successful treatment. Case summary: A 68- year- old woman with a 12- year history of RA developed a leg ulcer after 4 months of leflunomide treatment. Other ulcerogenic factors were ruled out. There were some clinical hints for rheumatoid vasculitis. The ulcer was resistant to ambulant conservative phase adapted wound bed preparation and a split skin transplantation failed. After omission of leflunomide and washout procedure with cholestyramine a second split skin transplantation resulted in complete healing. Discussion: Leflunomide inhibits the division of activated T cells and thus inhibits among others the production of proinflammatory cytokines and the adhesion of cells to the endothelium. These mechanisms may partly explain the possible influence of leflunomide on the perpetuation of the ulcer. Until now, occurrence of vasculitis and leg ulcers has been described in one case each for the novel immunomodulator leflunomide. No successful treatment of a leg ulcer under leflunomide has been described yet. Omission of leflunomide and a washout treatment in our case led to a complete healing. This may indicate a critical role of leflunomide in the maintenance of this slow healing ulcer. Conclusions: An association between leflunomide intake, occurrence of leg ulcers in RA patients and delayed wound healing should be considered.
文摘Klinefelter’ s syndrome is the most frequent major abnormality of sexual differentiation in men with two or more X chromosomes. Recurrent venous ulcers as a result of a post- thrombotic syndrome are a well known symptom in patients with Klinefelter’ s syndrome. Until now the underlying pathomechanisms are not completely understood. Platelethyperaggregability,factor V Leiden mutation and abnormalities in fibrinolysis were implicated as possible contributing factors. Here we describe the detection of an increased activity of factor VIII coagulant (factor VIII: C). This is the first case report on increased factor VIII: C activity associated with venous ulcers in a patient with Klinefelter’ s syndrome. Elevated factor VIII plasma levels are gradually accepted to be associated with an increased risk for venous thromboembolism. Therefore, we discuss that the examination of factor VIll: C may help in clarifying individual thromboembolic risks, especially in patients with Klinefelter’ s syndrome.
文摘Linear IgA dermatosis (LAD) is a well-recognized acquired subepidermal bullous autoimmune disease. LAD is characterized by clinical, histopathological and immunopathological findings. We report the case of a 38-year-old man who suffered from a chronic myeloic leukaemia. Although he received immunosuppressive therapy he developed LAD after an allogenic bone marrow transplantation. After diagnosis of LAD was establishedwestartedasuccessfulsystemictherapywithdapsone, while continuing the preliminary medication. Here we report for the first time on a possible relationship between LAD and bone marrow transplantation in an immunosuppressed patient.
