Angiokeratoma Corporis Diffusum: An Uncommon Case with Suspected Anderson Fabry Disease

Abstract

Angiokeratomas are variable sized hyperkeratotic vascular papules that are characterized histologically by superficial dilated capillaries in papillary dermis with epidermal proliferation. They can occur as a single lesion to a generalized form (angiokeratoma corporis diffusum). Angiokeratoma corporis diffusum though initially synonymous with Anderson Fabry disease, is now known to occur in a variety of lysosomal enzyme deficiencies. We report a case of 22 year old male with angiokeratoma corporis diffusum associated with acroparesthesias, febrile episodes, sensorineural hearing loss and renal involvement. Histopathological evaluation showed characteristic ectatic blood vessels with vacuolated endothelial cells in papillary dermis. Based on the clinical evaluation and available investigations, we suspected him to be having to Anderson fabry disease. Resource constraints limited our ability to confirm our diagnosis with enzyme assay and electron microscopy. We report this unusual case in desire of re emphasizing the importance of clinical evaluation for reaching a diagnosis in a resource poor setting.

Keywords: Angiokeratoma; Fabry disease; systemic involvement.

Figure 1

Discrete angiomatous keratotic papules over the trunk and upper limb

Figure 2

Clustered angiokeratomas around (a) lower back. (b) knees. (c) penis. (d) buttocks

Figure 3

Hyperkeratosis and ectatic blood vessels seen in the papillary dermis (H and E 40×)

Figure 4

Presence of dilated capillaries lined with vacuolated endothelial cells in the papillary dermis (H and E 100×)