case_images: PMC11155309_01
case_images: ((a) and (b)) Large vegetative ulcer with malodorous, purulent, yellow/green drainage, extending from the proximal inner right thigh to the popliteal fossa. (c) Numerous pink to erythematous, indurated plaques and nodules extend from the right thigh to the dorsal aspect of the foot.
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case_images: PMC11155309_01_10.1177_2050313X241257678-fig1.jpg
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case_images: The wound began as four small vesicular lesions that progressively developed into numerous pink papules, nodules, and vesiculobullous lesions extending from his right thigh to the dorsal foot, with significant associated serosanguinous and purulent drainage (Figure 1). In addition, numerous pink to erythematous, indurated plaques and nodules extended from the right thigh to the dorsal foot, with grouped bullae on the medial right ankle (Figure 1).
case_images: ((a) and (b)) The punch biopsy of skin showing dermal-based infiltrating vascular proliferation formed by meshwork of anastomosing vascular channels dissecting the collagen and lined by a single endothelial layer with minimal atypia (Hematoxylin & Eosin, right thigh, x100 and x200). (c) Clinically vesiculobullous area disclosed papillary dermal edema, dilated vascularity, and hemorrhage (Hematoxylin & Eosin, right thigh, x50). (d) Immunohistochemical stain for human herpesvirus-8 (HHV-8) displayed strong nuclear positivity in the endothelial lining cells (HHV-8, right thigh, x50). (e) Immunohistochemical stain for CD31 displayed strong positivity in the endothelial lining cells highlighting the meshwork of anastomosing vessels (CD31, right thigh, x50).
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case_images: Two skin punch biopsies from the anterior thigh revealed poorly circumscribed dermal based vascular proliferation composed of a meshwork of numerous anastomosing vascular channels dissecting the collagen bundles and lined by a single layer of endothelium without cellular stratification (Figure 2(a) and (b)). One of the biopsies showed corresponding papillary dermal edema in the clinical vesiculobullous area (Figure 2(c)). HHV-8 stain showed strong and diffuse nuclear positivity in lesional cells (Figure 2(d)). CD31 highlighted the lining cells (Figure 2(e)); however, smooth muscle actin staining was lost around the proliferating channels.
case_images: (a) Appearance of right inner thigh subsequent to palliative radiation and initiation of liposomal doxorubicin. (b) Progression of grouped vesiculobullous lesions with surrounding indurated papulonodules involving the medial right ankle which was not initially treated with radiation.
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case_images: Treatment was well-tolerated, with noted improvement of the right thigh wound (Figure 3).