Treatment of Refractory Leg Ulcer in a Patient With Lupus Undergoing Combination Therapies

Background. Systemic lupus erythematosus can present with refractory chronic leg ulcers, often linked to antiphospholipid syndrome or vasculopathy. Standard immunosuppressive therapy may be unsuccessful in such cases, necessitating alternative approaches such as anticoagulation and advanced wound care. Case report. This report presents the case of a 46-year-old male with systemic lupus erythematosus who developed a persistent leg ulcer on the right lateral ankle that was unresponsive to immunosuppressive treatment of more than 6 months’ duration. A short-term multimodal therapeutic approach incorporating anticoagulation, negative pressure wound therapy, and cultured epidermal homograft successfully induced robust granulation and marked epithelialization with 1 week of hospitalization, a much shorter period than the previously reported 2 months needed for full resolution with anticoagulation alone. Although in the present case complete epithelial closure was not achieved during the brief inpatient period, the wound showed near-total epithelialization with continued outpatient care, indicating rapid and stable wound recovery. This case demonstrates that adjunctive use of negative pressure wound therapy and cultured epidermal homograft appears to shorten the healing process compared with anticoagulation therapy alone. Conclusion. This case underscores the efficacy of multimodal therapy—integrating anticoagulation, negative pressure wound therapy, and cultured epidermal homograft—in rapid induction of granulation and epithelialization of refractory ulcers in a patient with antiphospholipid syndrome-negative systemic lupus erythematosus, highlighting vasculopathy as a potential mechanism amenable to such interventions.