TITLE:
Successful Management of a Complicated Ulcer Caused by Autoimmune Vasculitis, with Sildenafil Citrate in a Patient with Primary Antiphospholipid Syndrome and Transient Steroid-Induced Diabetes Mellitus: A Case Report and Literature Review
AUTHORS:
Fernando Grover-Páez, Leonel García-Benavides, Ernesto Germán Cardona-Muñóz, Carlos Gerardo Ramos-Becerra, Jesús Ricardo García-Corral, Carlos Enrique Medina-García, Guillermo Adrián Alanis-Sánchez, Sylvia Elena Totsuka-Sutto
KEYWORDS:
Autoimmune Vasculitis, Sildenafil Citrate, Steroid-Induced Diabetes Mellitus, Primary Antiphospholipid Syndrome
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.3,
July
31,
2014
ABSTRACT: Antiphospholipid syndrome
(APS) is a prothrombotic condition that can affect both the venous circulation
and the arterial system. The deep veins of the lower extremities and cerebral
blood flow are the most common sites of venous and arterial thrombosis,
respectively. Skin ulceration and gangrene may be associated with an active
vasculitis in patients with APS. These kinds of ulcers are considered intractable
because healing is difficult to achieve. Using steroids as immunesuppressant
therapy is still a basic part of managing APS and vasculitis. Nevertheless, in
the presence of steroid-induced diabetes mellitus, the priority is to achieve
faster wound healing, because of the potential complications that can develop
due to metabolic dysfunction and augmented vulnerability to infection. Until
recently, there were few reports demonstrating the benefits of the use of
adjuvant phosphodiesterase-5 inhibitors like sildenafil citrate in different
clinical entities with courses like Raynaud’s phenomenon, scleroderma, and
resistance to vasodilator therapy. We present the first report demonstrating
the additional benefit of sildenafil citrate for the integration of grafts in a
patient with steroid-induced diabetes and APS who had ulcers due to vasculitis
resistant to the usual vasodilator therapy.