Clinical case of cutaneous vasculopathy due to mutation of prothrombin gene F2(20210)GA

The article describes a case of skin vasculopathy due to systemic coagulopathy. In the setting of complete well-being, a 37-year-old female patient developed extensive areas of skin necrosis, predominantly in the lower extremities, over a period of 3 months. At the initial visit to the dermatovenerologic dispensary, papulonecrotic vasculitis was diagnosed, and systemic therapy with glucocorticosteroids was prescribed, which turned out to be ineffective. A repeated histological examination carried out at the Skin and Venereal Diseases Clinic of the Military Medical Academy allowed to make a final diagnosis — occlusive vasculopathy. When evaluating the coagulogram, the patient was found to have elevated prothrombin level (165 %) and a slight decrease in aPTT (22.3 s). Considering the normal platelet count, absence of concomitant visceral pathology, lack of history of warfarin use, and past infections, the patient’s condition was regarded as a manifestation of systemic coagulopathy. A search for possible causes of hypercoagulation revealed a significant mutation in the prothrombin gene F2(20210)GA. Anticoagulant therapy was initiated after consultation with a hematologist. Taking into account the large area of ulcerative skin defects, the patient was transferred to a surgical inpatient facility for further treatment. Thanks to the joint work of specialists in Dermatology, Hematology, and Surgery, it was possible to achieve healing of skin defects without plastic surgery, as well as to prevent repeated thrombotic events (no relapses during 6 months of follow-up).