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

A case of skin vasculopathy due to systemic coagulopathy is described. A 37-year-old female patient developed extensive necrosis zones within 3 months of complete well-being skin mainly in the lower extremities. At the initial visit to the dermatovenerological dispensary, a diagnosis of papulonecrotic vasculitis was made, systemic therapy with glucocorticosteroids was prescribed, which turned out to be ineffective. Repeated histological examination carried out in the clinic of skin and sexually transmitted diseases of the Military Medical Academy made it possible to make a final diagnosis - occlusive vasculopathy. When assessing the coagulogram, the patient had an increased level of prothrombin (165%) and a slight decrease in aPTT (22.3 s). Considering the normal platelet count, absence of concomitant internal pathology, lack of history of warfarin use, past infections, the patient's condition was regarded as a manifestation of systemic coagulopathy. During the search for possible causes of hypercoagulation, a significant mutation of the prothrombin F2 (20210) GA gene was revealed. After consultation with a hematologist, anticoagulant therapy was started. Taking into account the large area of ulcerative skin defects, the patient was transferred to a surgical hospital for further treatment. Thanks to the joint work of specialists in dermatological, hematological and surgical profiles, 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).