Multiple choice: lower extremity ulcer

Abstract

A 36-year-old male patient, from Tafí Viejo, Tucumán province, with a history of hospitalization in 2019 due to polyneuropathy and oligoarthritis of more than 6 years of evolution, without a definitive diagnosis. He was admitted on call in poor general condition, with skin-mucous pallor, generalized edema, oligoanuria, walking disorders, hypotension, and hyperglycemia. During hospitalization, after 20 days, he developed an ulcer 10 cm in diameter, located on the anterolateral aspect of the left leg, with a defined, raised edge, with a purpuric peripheral halo and a necrotic background, cold to the touch and painful to the touch. palpation. At the perianal level, he presented an ischiorectal abscess. A biopsy of the ulcer was performed for histopathological and laboratory study with a complete rheumatological profile. Pancytopenia, renal failure, hypernatremia, negative serologies and positive anticitrullinated peptide (anti-CCP) antibody were evidenced. He was admitted to the operating room for drainage of the ischiorectal abscess. After 3 days, he died due to multiple organ failure.