Successful Management of a Complicated Ulcer Caused by Autoimmune Vasculitis, with Sildenafil Citrate in a Patient with Primary Antiphospholipid Syndrome and Transient Steroid-Induced Diabetes Mellitus: A Case Report and Literature Review
- 1 Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
- 2 Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
- 3 Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
- 4 Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
- 5 Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
- 6 Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
- 7 Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
- 8 Institute of Experimental and Clinical Therapeutics, Department of Physiology, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
Abstract
Antiphospholipid syndrome (APS) is a prothrombotic condition that can affect both the venous circulation and the arterial system. The deep veins of the lower extremities and cerebral blood flow are the most common sites of venous and arterial thrombosis, respectively. Skin ulceration and gangrene may be associated with an active vasculitis in patients with APS. These kinds of ulcers are considered intractable because healing is difficult to achieve. Using steroids as immunesuppressant therapy is still a basic part of managing APS and vasculitis. Nevertheless, in the presence of steroid-induced diabetes mellitus, the priority is to achieve faster wound healing, because of the potential complications that can develop due to metabolic dysfunction and augmented vulnerability to infection. Until recently, there were few reports demonstrating the benefits of the use of adjuvant phosphodiesterase-5 inhibitors like sildenafil citrate in different clinical entities with courses like Raynaud’s phenomenon, scleroderma, and resistance to vasodilator therapy. We present the first report demonstrating the additional benefit of sildenafil citrate for the integration of grafts in a patient with steroid-induced diabetes and APS who had ulcers due to vasculitis resistant to the usual vasodilator therapy.
- Brandt, J.T., Triplett, D.A., Alving, B. and Scharrer, I. (1995) Criteria for the Diagnosis of Lupus Anticoagulants: An Update. Thrombosis and Haemostasis, 74, 1185-1190.
- Miyakis, S., Lockshin, M.D., Atsumi, T., et al. (2006) International Consensus Statement on an Update of the Classification Criteria for Definite Antiphospholipid Syndrome (APS). Journal of Thrombosis and Haemostasis, 4, 295-306. http://dx.doi.org/10.1111/j.1538-7836.2006.01753.x
- Cervera, R., Piette, J.C., Font, J., et al. (2002) Antiphospholipid Syndrome: Clinical and Immunologic Manifestations and Patterns of Disease Expression in a Cohort of 1000 patients. Arthritis Rheumatology, 46, 1019-1027. http://dx.doi.org/10.1002/art.10187
- Vega-Ostertag, M., Casper, K., Swerlick, R., Ferrara, D., Harris, E.N. and Pierangeli, S.S. (2005) Involvement of p38 MAPK in the Up-Regulation of Tissue Factor on Endothelial Cells by Antiphospholipid Antibodies. Arthritis Rheumatology, 52, 1545-1554. http://dx.doi.org/10.1002/art.21009
- Vega-Ostertag, M.E., Ferrara, D.E., Romay-Penabad, Z., Liu, X., Taylor, W.R., Colden-Stanfield, M., et al. (2007) Role of p38 Mitogen-Activated Protein Kinase in Antiphospholipid Antibody Mediated Thrombosis and Endothelial Cell Activation. Journal of Thrombosis and Haemostasis, 5, 1828-1834. http://dx.doi.org/10.1111/j.1538-7836.2007.02680.x
- Routy, B., Huynh, T., Fraser, R. and Séguin, C. (2013) Vascular Endothelial Cell Function in Catastrophic Antiphospholipid Syndrome: A Case Report and Review of the Literature. Case Reports in Hematology, 2013, Article ID: 710365.
- Lim, W. (2013) Antiphospholipid Syndrome. Hematology—American Society of Hematology Education Program, 2013, 675-680. http://dx.doi.org/10.1182/asheducation-2013.1.675
- Pudusseri, A., Shameem, R. and Spyropoulos, A.C. (2013) A New Paradigm Shift in Antithrombotic Therapy. Frontiers in Pharmacology, 4, 133. http://dx.doi.org/10.3389/fphar.2013.00133
- Kotila, T.R., Olutogun, T. and Ipadeola, A. (2013) Steroid Induced Diabetes Mellitus in Patients Receiving Prednisolone for Haematological Disorders. African Health Sciences, 13, 842-844
- Toyozawa, S., Yamamoto, Y., Kishioka, A., Yonei, N., Kanazawa, N., Matsumoto, Y., et al. (2009) Effective Treatment of Intractable Skin Ulcers Using Allogeneic Cultured Dermal Substitutes in Patients with Systemic Lupus Erythematosus. European Journal of Dermatology, 19, 594-596.
- Waqar, A.J., Habit, U.S., et al. (2009) Management of Diabetic Foot According to Wagner Classification and Frequency of Diabetic Foot Disease. Journal of Postgraduate Medical Institute, 23, 245-250.