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Acroangiodermatitis associated with iatrogenic arteriovenous fistula mimicking verruca vulgaris.

Kudligi C, Bhagwat PV, Asati DP, Lingaiah KS, Odugoudar SG - Indian J Dermatol (2015 Mar-Apr)

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Venereology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. E-mail: drchandramohanaiims@gmail.com.

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Sir, A 50-year-old male on dialysis for chronic renal failure presented to us with a six-month history of a gradually increasing, mildly painful, warty lesion on the left hand... The patient recollects the onset of the lesion to be after three months of starting dialysis through an arteriovenous fistula created on the left forearm... The term acroangiodermatitis was introduced in 1965 by Mali et al., who described peculiar mauve-colored macules and plaques on the extensor surface of feet in 18 patients with chronic venous insufficiency; since then, pseudo-Kaposi's sarcoma has been reported in association with various conditions like arteriovenous fistulae, paralyzed limbs, amputation stumps, vascular syndromes, conditions associated with thrombosis, and rarely with placement of the arteriovenous shunt for hemodialysis in chronic renal failure... This is evidenced by the disappearance of the pseudo-Kaposi's sarcoma which was observed in our patient after successfully correcting the arteriovenous fistula and starting him on peritoneal dialysis... Histopathologic examination shows proliferation of endothelial cells and newly formed vessels with thick walls, often in a lobular pattern and surrounded by pericytes in the dermis... Extravasation of red blood cells, hemosiderin pigment deposition, dermal fibrosis, small thrombi in the lumen, and superficial perivascular infiltrate of lymphocytes, histiocytes, and occasional plasma cells are also found and may resemble Kaposi's sarcoma... This, however, has vascular slits, proliferation of fusiform cells and atypical cells, and the vascular hyperplasia is independent of pre-existing vasculature... Treatment of acroangiodermatitis is barely discussed in the literature and depends upon the nature of underlying circulatory disturbance... Various treatment modalities tried with reasonable successes are compression stockings, oral erythromycin, oral dapsone, topical steroid preparations, and in some cases, pulsed dye laser ablation... Pseudo-Kaposi's sarcoma following iatrogenic arteriovenous fistula is a rare complication in patients on dialysis... A Pubmed search located only nine case reports between 1965 and 2013.

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Complete subsidence of the lesions after three months of correcting arteriovenous fistula
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Figure 3: Complete subsidence of the lesions after three months of correcting arteriovenous fistula

Mentions: A 50-year-old male on dialysis for chronic renal failure presented to us with a six-month history of a gradually increasing, mildly painful, warty lesion on the left hand. The lesion initially started as a smooth-surfaced soft swelling of peanut size, which gradually changed to become verrucous, covering the entire dorsum of the hand and fingers over a period of six months. The patient recollects the onset of the lesion to be after three months of starting dialysis through an arteriovenous fistula created on the left forearm. He consulted a local doctor who performed electrocautery after making a clinical diagnosis of verruca vulgaris. During the postprocedure period of one week, the patient experienced increase in the size of the lesion, increase in the severity of pain, and constant oozing of blood and serum from the eroded surface. The patient was referred to us with the above-mentioned complaints for further evaluation and management. On examination, there were multiple discrete-to-colasing, erythematous, minimally tender soft compressible verrucous papules and nodules covering the dorsal aspect of the left hand and proximal aspects of the fingers [Figure 1]. Differential diagnoses of Kaposi's sarcoma and acroangiodermatitis were considered. Blood investigation revealed hemoglobin 10 g/dL, erythrocyte sedimentation rate 30 mm at first hour, blood urea 50 mg/dL, and serum creatinine 3 mg/dL. Rest of the hematological and biochemical parameters were within normal limits including liver function tests. The patient also tested negative for HIV antibodies and hepatitis B antigen. The nodule over the dorsum of the hand was biopsied and subjected to histopathological examination. It showed multiple dilated capillaries with extravasation of erythrocytes and irregular acanthotic epidermis [Figure 2]. There were no slit-like vascular spaces, spindle cell proliferation, or atypical cells. Based on clinical history, cutaneous examination, presence of iatrogenic arteriovenous fistula, and histopathological features, we made a final diagnosis of acroangiodermatitis. The patient was started on peritoneal dialysis after correcting the arteriovenous fistula on the left forearm. All the lesions subsided completely, leaving behind a thin scar [Figure 3]. The patient is being followed up for the past one year without any signs of recurrence.


Acroangiodermatitis associated with iatrogenic arteriovenous fistula mimicking verruca vulgaris.

Kudligi C, Bhagwat PV, Asati DP, Lingaiah KS, Odugoudar SG - Indian J Dermatol (2015 Mar-Apr)

Complete subsidence of the lesions after three months of correcting arteriovenous fistula
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372966&req=5

Figure 3: Complete subsidence of the lesions after three months of correcting arteriovenous fistula
Mentions: A 50-year-old male on dialysis for chronic renal failure presented to us with a six-month history of a gradually increasing, mildly painful, warty lesion on the left hand. The lesion initially started as a smooth-surfaced soft swelling of peanut size, which gradually changed to become verrucous, covering the entire dorsum of the hand and fingers over a period of six months. The patient recollects the onset of the lesion to be after three months of starting dialysis through an arteriovenous fistula created on the left forearm. He consulted a local doctor who performed electrocautery after making a clinical diagnosis of verruca vulgaris. During the postprocedure period of one week, the patient experienced increase in the size of the lesion, increase in the severity of pain, and constant oozing of blood and serum from the eroded surface. The patient was referred to us with the above-mentioned complaints for further evaluation and management. On examination, there were multiple discrete-to-colasing, erythematous, minimally tender soft compressible verrucous papules and nodules covering the dorsal aspect of the left hand and proximal aspects of the fingers [Figure 1]. Differential diagnoses of Kaposi's sarcoma and acroangiodermatitis were considered. Blood investigation revealed hemoglobin 10 g/dL, erythrocyte sedimentation rate 30 mm at first hour, blood urea 50 mg/dL, and serum creatinine 3 mg/dL. Rest of the hematological and biochemical parameters were within normal limits including liver function tests. The patient also tested negative for HIV antibodies and hepatitis B antigen. The nodule over the dorsum of the hand was biopsied and subjected to histopathological examination. It showed multiple dilated capillaries with extravasation of erythrocytes and irregular acanthotic epidermis [Figure 2]. There were no slit-like vascular spaces, spindle cell proliferation, or atypical cells. Based on clinical history, cutaneous examination, presence of iatrogenic arteriovenous fistula, and histopathological features, we made a final diagnosis of acroangiodermatitis. The patient was started on peritoneal dialysis after correcting the arteriovenous fistula on the left forearm. All the lesions subsided completely, leaving behind a thin scar [Figure 3]. The patient is being followed up for the past one year without any signs of recurrence.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology and Venereology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India. E-mail: drchandramohanaiims@gmail.com.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Sir, A 50-year-old male on dialysis for chronic renal failure presented to us with a six-month history of a gradually increasing, mildly painful, warty lesion on the left hand... The patient recollects the onset of the lesion to be after three months of starting dialysis through an arteriovenous fistula created on the left forearm... The term acroangiodermatitis was introduced in 1965 by Mali et al., who described peculiar mauve-colored macules and plaques on the extensor surface of feet in 18 patients with chronic venous insufficiency; since then, pseudo-Kaposi's sarcoma has been reported in association with various conditions like arteriovenous fistulae, paralyzed limbs, amputation stumps, vascular syndromes, conditions associated with thrombosis, and rarely with placement of the arteriovenous shunt for hemodialysis in chronic renal failure... This is evidenced by the disappearance of the pseudo-Kaposi's sarcoma which was observed in our patient after successfully correcting the arteriovenous fistula and starting him on peritoneal dialysis... Histopathologic examination shows proliferation of endothelial cells and newly formed vessels with thick walls, often in a lobular pattern and surrounded by pericytes in the dermis... Extravasation of red blood cells, hemosiderin pigment deposition, dermal fibrosis, small thrombi in the lumen, and superficial perivascular infiltrate of lymphocytes, histiocytes, and occasional plasma cells are also found and may resemble Kaposi's sarcoma... This, however, has vascular slits, proliferation of fusiform cells and atypical cells, and the vascular hyperplasia is independent of pre-existing vasculature... Treatment of acroangiodermatitis is barely discussed in the literature and depends upon the nature of underlying circulatory disturbance... Various treatment modalities tried with reasonable successes are compression stockings, oral erythromycin, oral dapsone, topical steroid preparations, and in some cases, pulsed dye laser ablation... Pseudo-Kaposi's sarcoma following iatrogenic arteriovenous fistula is a rare complication in patients on dialysis... A Pubmed search located only nine case reports between 1965 and 2013.

No MeSH data available.


Related in: MedlinePlus