Painful leg ulcers and a rash in a patient with polycythaemia rubra vera. Diagnosis: hydroxyurea-induced leg ulceration and dermatomyositis-like skin changes.

摘要

A 52-year-old woman presented with a 4-month history of painful leg ulcers, which had failed to heal with conservative treatment. She had been on hydroxyurea 1.5 g twice daily for 5 years for polycythaemia rubra vera. On examination, she had a small ulcer over her left lateral malleolus (Fig. 1) and another above the left heel. There were several white atrophic scars on the legs and feet. She also had widespread telangiectases, a violaceous facial rash, dilated nail-fold capillaries with ragged cuticles, and purple papules over the interpha-langeal joints (Fig. 2). There was no muscle weakness. Creatinine kinase and an autoantibody screen were negative.