Hidden Diagnosis - Chronic Non-Healing Leg Ulcer

Abstract

Chronic ulcers present a significant clinical challenge, often necessitating tailored, multi-faceted interventions and strict adherence to treatment protocols. Accurate diagnosis and management require a thorough understanding of the ulcer's etiology and associated systemic conditions. This case report highlights a 35-year-old male with a chronic non-healing leg ulcer, compounded by a history of deep vein thrombosis (DVT) and pulmonary thromboembolism. Despite negative findings for common vasculitic and procoagulant profiles, a biopsy revealed leukocytoclastic vasculitis, and subsequent HLA-B51 testing confirmed the diagnosis of Behçet’s disease. The patient was treated with a combination of prednisolone, mycophenolate mofetil, and rivaroxaban, resulting in notable regression of the ulcer. This case underscores the importance of considering Behçet’s disease in young male patients presenting with chronic non-healing ulcers and thromboembolic events. Early diagnosis and vigilant, multidisciplinary management are essential to mitigate complications such as pulmonary artery hemorrhage and neuro-Behçet’s disease. This report emphasizes the need for comprehensive diagnostic approaches and long-term follow-up to prevent irreversible organ damage and improve patient outcomes.