Leg Ulcer in Patient with Sickle Cell Disease on Hydroxyurea
Sickle cell disease is a chronic disease caused by mutation of the HBB gene,
leading to the replacement of β-globin with abnormal hemoglobin S in hemoglobin subunits.
Sickled blood cells have a short lifespan and complications include blocked
blood vessels, acute chest disorder, infection, organ damage and stroke.
Hydroxyurea therapy was approved by the Food and Drug
Administration in 1998 and decreases the number of pain
crises in sickle cell patients.
It increases the level of fetal hemoglobin in sickle cell patients,
lessening hemoglobin S polymerization.
There have been numerous dermatological side effects
noted, including skin atrophy, palmoplantar keratoderma,
alopecia, and cutaneous and mucosal ulcers.
We describe a case of a leg ulcer in a patient with sickle
cell disease on hydroxyurea. Painful hydroxyurea induced leg ulcers
have been reported in patients with myeloproliferative disorders.
Physical examination showed stable vitals. Focused exam on the
left ankle showed a unilateral ulcer on the patient’s left malleolus.
There were 2 smaller ulcers adjacent to the primary ulcer in various phases of healing.
There was no evidence of right or left lower
extremity deep venous thrombosis. The right greater saphenous
vein was patent and small. The left greater saphenous vein was
also patent and small and was only identifiable in the thigh and
Intern Med Open J. 2020; 4(1): 13-15. doi: 10.17140/IMOJ-4-114