Martorell’s Hypertensive Ischemic Leg Ulcer: A Case of Mistaken Identity

Introduction: 45-year-old female presented to the wound care clinic with an atypical wound to the left medial lower extremity. The patient reported trauma at the etiology resulting in a small black bump that gradually worsened. Past medical history is positive for morbid obesity, severe OSA, and Htn. Social history is positive for smoking 1 ppd x 10 years. The wound presented with eschar and extremely painful. The rest of the history was benign. Methods: Laboratory testing showed elevated inflammatory markers. Imaging was negative. Sharp debridement was performed with a punch biopsy to the margin. Pathology was nonspecific- concern for stasis der- matitis vs PG. The pt was started on high dose steroids. There was wors- ening pain, size and overall appearance. A wedge biopsy was performed and sent to dermatopathology. Results showed marked hyperplastic me- dia of midsized arterioles with complete occlusion of lumen and calcium deposition, suggestive for Martorell’s Hypertensive Ischemic Leg Ulcer. Results: Steroids were rapidly tapered. The patient was started on calcium channel blockers. Extensive debridement was performed and NPWT and 4-layer compression was utilized until the wound was appropriate for a split thickness skin graft. The wound showed dramatic improvement with the above interventions with eventual healing. Discussion: This case represents the importance of identifying Mar- torell’s Hypertensive Ischemic Leg Ulcer and differentiating between Pyoderma Gangrenosum and Vasculitis as the treatments are completely divergent.