u/GlauberVAMG

Hi everyone,

Posting about my wife (30F, Black Brazilian, non-smoker, no known medical conditions, no allergies, no relevant family history).

She developed a lesion near the medial ankle about 1 year ago. It started as a small purplish spot and progressively ulcerated into a chronic non-healing wound.

Key points:

Duration: ~1 year, non-healing

Location: medial ankle

Pain: severe (burning, stabbing, pulling/tight sensation), worse at night

Poor response to multiple analgesics including opioids (tramadol, morphine, methadone)

No clinical signs of infection (no odor, normal labs)

Investigations and prior management:

Doppler ultrasound: normal arterial and venous flow (large vessels only, microcirculation not assessed).

Biopsy: pseudoepitheliomatous hyperplasia, fibrosis, hemosiderin deposition; no infection or malignancy identified

Previously followed by a wound care clinic (including debridement and Unna boot compression), without improvement

We are still without a clear diagnosis and trying to understand possible directions for further evaluation.

I would really appreciate:

Any similar experiences (especially chronic ulcers with severe neuropathic pain + normal Doppler)

Any possible differential diagnoses or conditions worth considering given that she has already been evaluated by dermatology, vascular surgery, wound care, and other specialists without a clear diagnosis

Anything that helped with pain management or quality of life while investigating the cause (including nerve blocks if applicable)

Thank you.

Edit:

UPDATE: We went to dermatologist today, talked about Pyoderma Gangrenosum, but they don't believe she have it.

The doctors did not consider it a rheumatology case and did not refer her to a rheumatologist after evaluation.

This time they prescribed low-dose aspirin (AAS) and ordered a CT angiography of the lower limbs (CTA of the legs), which is a contrast-enhanced CT scan used to evaluate the blood vessels in detail.

They are now focusing more on vascular causes rather than rheumatologic ones.

Hi everyone,

Posting about my wife (30F, Black Brazilian, non-smoker, no known medical conditions, no allergies, no relevant family history).

She developed a lesion near the medial ankle about 1 year ago. It started as a small purplish spot and progressively ulcerated into a chronic non-healing wound.

(Photos show progression: early stage → ulcer formation → current appearance.)

Key points:

Duration: ~1 year, non-healing

Location: medial ankle

Pain: severe (burning, stabbing, pulling/tight sensation), worse at night

Poor response to multiple analgesics including opioids (tramadol, morphine, methadone)

No clinical signs of infection (no odor, normal labs)

Investigations and prior management:

Doppler ultrasound: normal arterial and venous flow (large vessels only, microcirculation not assessed).

Biopsy: pseudoepitheliomatous hyperplasia, fibrosis, hemosiderin deposition; no infection or malignancy identified

Previously followed by a wound care clinic (including debridement and Unna boot compression), without improvement

We are still without a clear diagnosis and trying to understand possible directions for further evaluation.

I would really appreciate:

Any similar experiences (especially chronic ulcers with severe neuropathic pain + normal Doppler)

Any possible differential diagnoses or conditions worth considering given that she has already been evaluated by dermatology, vascular surgery, wound care, and other specialists without a clear diagnosis

Anything that helped with pain management or quality of life while investigating the cause (including nerve blocks if applicable)

Thank you.

Hi everyone,

Posting about my wife (30F). She developed a lesion near the medial ankle about 1 year ago. It started as a small purplish spot, then opened and progressed into a chronic ulcer that hasn’t healed.

(I’ve included photos showing the progression — early stage → when it opened → current state.

Key points:

Duration: ~1 year, non-healing

Location: medial ankle

Pain: severe (burning, stabbing, pulling/tight sensation), worse at night

Pain has not responded to opioids (tramadol, morphine, methadone)

No clear infection (no odor, labs normal)

Tests done:

Doppler ultrasound → normal arterial and venous flow (large vessels only; microcirculation not assessed)

Biopsy → pseudoepitheliomatous hyperplasia, fibrosis, hemosiderin, no infection or malignancy

Doctors haven’t identified a clear cause yet and we’re still in the process of figuring this out.

I would really appreciate:

If anyone has experienced something similar (especially ulcers with severe neuropathic pain + normal Doppler)

What kind of specialist or diagnostic path helped in your case (dermatology, rheumatology, vascular, pain clinic, etc.)

Anything that helped manage the pain or improved quality of life while searching for answers. Has a nerve block helped anyone in a similar situation?

Just trying to learn from others’ experiences and understand possible directions to explore next.

We’ve seen multiple specialists over the past year without a clear diagnosis yet.

Thank you.

Edit: UPDATE: We went to dermatologist today, talked about Pyoderma Gangrenosum, but they don't believe she have it.

The doctors did not consider it a rheumatology case and did not refer her to a rheumatologist after evaluation.

This time they prescribed low-dose aspirin (AAS) and ordered a CT angiography of the lower limbs (CTA of the legs), which is a contrast-enhanced CT scan used to evaluate the blood vessels in detail.

They are now focusing more on vascular causes rather than rheumatologic ones.