https://orcid.org/0000-0002-0121-1083
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Callum Riley, Sanaa Butt, Nomathamsanqa Mathe, Owen Cain, Ghazia Kaushal, Bilateral lower limb ulceration in a patient with a malignancy, Clinical and Experimental Dermatology, Volume 50, Issue 5, May 2025, Pages 1066–1068, https://doi.org/10.1093/ced/llae536
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Clinical findings
An 81-year-old woman presented acutely to the Queen Elizabeth Hospital Birmingham, UK, with a 5-week history of progressive and painful bilateral lower limb ulcers. The patient denied any trauma to the areas. The larger ulcer of the right leg had first appeared 5 weeks previously as two small, painful blisters, which subsequently coalesced and ulcerated. In a community setting, she had received a 2-week course of oral flucloxacillin, 1000 mg four times daily, and betamethasone valerate 0.1% ointment to apply topically. She had used no other medications in recent months. The ulcers continued to increase in size despite her good compliance with the prescribed treatments. The patient also reported a recent history of weight loss.
The patient’s medical history included type 2 diabetes, hypertension and chronic kidney disease with a baseline Cockcroft–Gault glomerular filtration rate (GFR) of 48.47 mL min–1 and baseline creatinine of 100–130 µmol L–1. On examination of the right posterior calf, there was an area, 25 × 50 mm, of stellate-shaped superficial ulceration with overlying black eschar. There was surrounding erythema (Figure 1). This wound was debrided to reveal well-demarcated ulcer edges with a base of green–yellow slough (Figure 2). On the left leg, there was a 10 × 10 mm scaly plaque that was not yet ulcerated.
