A man with Klinefelter's syndrome (KS) may develop recurrent leg and foot cutaneous ulcers.


Clinical features:

(1) male with Klinefelter's syndrome

(2) chronic, recurrent ulcers over the legs and feet

(3) low serum concentration of testosterone

(4) high serum concentrations of plasminogen activator inhibitor-1 (PAI-1), which is associated with venous thromboemboli secondary to impaired fibrinolysis


The differential diagnosis includes other causes of hypercoagulability, vasculitis, venous insufficiency and cryoglobulinemia.


Therapy with testosterone normalizes (reduces) the PAI-1 levels and results in resolution of the skin ulcerations.


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