Cutaneous Hemorrhages and Gangrenes Localized to the Lower Limbs in Patients with Collagen Diseases and in Diabetics

Abstract

The appearance and development of cutaneous hemorrhages and gangrenes localized to the lower limbs in patients with certain systemic collagen diseases and in patients with purpura hyperglobulinemica Waldenstrom were compared to similar lesions in diabetics. There were characteristic differences, clinically as well as microscopically. The diabetic gangrene was clinically characterized by a surrounding zone of erythema. Such erythema was never seen in the patients with collagen diseases and gangrene. Especially in elderly diabetics, purpura was common and was localized to the erythematous areas of gangrenes as well as to non-erythematous areas. The cutaneous hemorrhages of the patients with collagen diseases were of varying size and were most often raised and palpable, in contrast to those in the diabetics. Large cutaneous hemorrhages in patients with collagen diseases often transformed into gangrenes. In diabetics, gangrene as well as purpura were generally precipitated by factors such as cardiac decompensation with edema of the legs. Such precipitating factors were not seen in the patients with collagen diseases.

In diabetics, the erythema adjacent to a cutaneous necrosis corresponded microscopically to dilated small blood vessels surrounded by only a small number of inflammatory cells. No thrombotic vessels were seen. In the patients with collagen diseases, thrombotic vessels were observed in the cutaneous areas adjacent to the necrosis. In and around the walls of the small blood vessels there was a pronounced deposition of inflammatory cells.