Chronic foot ulcer caused by Parkes Weber syndrome

Abstract

Dear Editors, A 62-year-old woman presented in our wound-healing department with an ulcer in the dorsum of her right foot, which already existed for 5 months. According to the patient anamnesis, painful reddish brown lesions occurred 8 months ago. A skin sample of these lesions was taken for further histopathological evaluation. As a result of this procedure, a non-healing ulcer of the dorsum of the foot developed. The patient underwent specific therapies, including diverse externa, wound dressings and systemic glucocorticoids, which have not led to any improvement. The patient denied any pre-existing diseases or injuries and does not take any regular medications.At the patient's first presentation in our clinic, the size of the ulcer was approximately 1⋅8 cm 2 . Clinically, it was covered with fibrin and very painful (8 of 10 points on the visual analogue scale). There were hypo-and hyperpigmentation in the ulcer's surroundings (Figure 1). According to that, deposits of haemosiderin were described in the histological sample. On further examination we found an angioma of 4 × 3 cm on the foot's sole, which existed since birth. Moreover, the right leg was approximately 1 cm longer than the left one.We performed a duplex sonography and plethysmography, which did not provide any evidence of venous insufficiency of the lower leg region. Although there were bruits, which could only be interrupted by the Valsalva manoeuvre, we accordingly suspected the existence of arteriovenous (AV)-shunts. This diagnosis was confirmed by the duplex sonography. A subsequently performed angiography showed multiple AV-shunts at the medial aspect of the dorsum of the foot (Figure 2). A magnetic resonance imaging (MRI) revealed a hypertrophic arteria