カルシフィラキシスの関与が疑われた下腿混合性皮膚潰瘍

・診断に苦慮した下腿皮膚潰瘍を経験した．

・臨床からカルシフィラキシスを疑ったが病理組織学的所見から否定された．

・静脈瘤の存在から大伏在静脈抜去術を行いいったん改善した．その後再度悪化したが大腿動脈内膜除去術後に潰瘍は縮小したため静脈性潰瘍と動脈性潰瘍の両者が関与した混合性潰瘍と診断した．

（「症例のポイント」より）

　

Calciphylaxis-like leg ulcers due to coexistence of arterial and venous diseases

　

Ikeda, Tomoyuki1）Sawada, Kaori1）Ishii, Takayuki1）Hatta, Naohito1） 1）Department of Dermatology, Toyama Prefectural Central Hospital

　

A 62-year-old male patient presented with a 2-month history of a painful leg ulcer. He had been receiving dialysis for 10 years, due to chronic renal failure. Physical and radiological examinations revealed necrotic ulcers on his right leg, enlarged varicose veins, and severe peripheral arterial disease. Skin biopsy findings lacked vascular calcification；thus, they were not consistent with calciphylaxis. Although the ulcer progressed after hospitalization, nearly complete healing was achieved after stripping the great saphenous vein, followed by femoral artery endarterectomy. The clinical course suggested that the leg ulcers were of mixed arterial-venous origin.