Progressive Vascular Anomalies and Musculoskeletal Symptoms in an Adult Patient

Presenter:  Valeria González-Molina, MD, Thomas L Davis, MD, Rick Lin, DO
Dermatology Program: South Texas Dermatology Residency, HCA Healthcare Corpus Christi Medical Center – Bay Area Program
Program Director: Rick Lin, DO MPH FAOCD

Submitted on: September 18, 2024

CHIEF COMPLAINT:  “I have many dark growths and bruises all over my arm ”

CLINICAL HISTORY:

Signs and symptoms: A 50-year-old male presented to our clinic with pain in his right hand and forearm that had been intermittently treated as cellulitis with oral antibiotics. The patient reported that he was born with a hemangioma on the right forearm, which has been growing in size and number over time. He denied trauma to the area and joint pain, but endorsed a limited range of motion affecting his daily activities. He also reports easy bruising. He denied any systemic symptoms, including fever, chills, shortness of breath, weight loss, and fatigue. He denied any history of recent travel or sick contacts. No other household members had similar lesions. His only pertinent surgical history was an excision of two subcutaneous lesions of the right antecubital fossa 20 years ago. The only medications the patient reported taking was gabapentin 300 mg BID. 

PHYSICAL EXAM:

Upon skin evaluation, the patient exhibited several ulcerated, hyperkeratotic violaceous plaques and firm, subcutaneous nodules on the right hand and forearm, extending beyond the right elbow. Additionally, violaceous macules and patches were observed. There was no noticeable discrepancy in limb size, and grip strength as well as sensation were intact and equal bilaterally.

RADIOLOGICAL STUDIES:

Radiological findings indicated the presence of soft tissue hemangioma with calcifications. There was also irregular skeletal expansion observed with thinning of the cortical bone and endosteal scalloping noted.

DERMATOHISTOPATHOLOGY:

N/A

DIFFERENTIAL DIAGNOSIS:

1. 1.   Arteriovenous Malformation
   2.   Kaposi’s Sarcoma
   3.   Maffucci Syndrome
   4.   Ollier Disease
   5.   Blue Rubber Bleb Nevus Syndrome
   6.   Klippel-Trenaunay Syndrome
   7.   Angiosarcoma
   8.   Vasculitis
   9.   Coagulopathy