Cutaneous Vasculopathy and Recalcitrant Lower-Extremity Ulcerations
Lower-extremity ulcerations are a frequent cause of hospitalization, and those that persist despite appropriate treatment warrant careful scrutiny. We present a case of chronic, progressive leg ulcerations in a young woman accompanied by oral and genital ulcers and retiform purpura. Repeat skin biopsy revealed an intravascular lymphoid infiltrate ultimately consistent with T-cell prolymphocytic leukemia, and she was treated successfully with alem-tuzumab and allogeneic hematopoietic stem cell transplantation. Our case illustrates the importance of maintaining a broad differential for patients with ulcers recalcitrant to treatment or with acute on chronic worsening. Our report also highlights the successful response of this aggressive disease to hematopoietic stem cell transplantation.
