Introduction. Hypertensive ischemic leg ulcer, also known as Martorell ulcer,
is not very rare, but an under-recognized type of leg ulcer. It has specific
clinical and histopathological characteristics. It occurs almost exclusively
in patients with arterial hypertension. It is more common in women and in
patients with type 2 diabetes. It is localized particularly in the
laterodorsal distal third of the lower leg. This ulcer is extremely painful.
Its clinical features may very much resemble pyoderma gangrenosum. Case
Report. We are presenting a case of a 40-year-old obese male, who suffered
from arterial hypertension during the past 26 years. His ulcer appeared
spontaneously on the lateral aspect of the right lower leg and progressed
gradually. From the very onset, the ulcer was extremely painful. At first,
it was diagnosed as pyoderma gangrenosum and treated with systemic
corticosteroids and immunosuppressants. Since the response to therapy was
not satisfactory, the histopathology was revised and the diagnosis of
hypertensive ischemic leg ulcer was made. After initial wound debridement
and local negative pressure therapy, split-thickness skin grafting was
performed. The pain disappeared right away almost completely and complete
epithelization was achieved two weeks after skin grafting. Conclusion. It is
important to consider Martorell ulcer in hypertensive patients with
extremely painful ulcers of the lower leg. In order to establish the
appropriate diagnosis, it is essential to take a deep skin biopsy and
correlate the finding with a specific histopathological picture. It is the
only way not to confuse hypertensive ischemic leg ulcer with pyoderma
gangrenosum, since the management of the two conditions is completely
different.
Leg ulcer in Werner syndrome (adult progeria): A case report