1/8. Typical features of calciphylaxis in a patient with end-stage renal failure, diabetes mellitus and oral anticoagulation.We report a multimorbid patient with end-stage renal failure showing a large necrosis and livedo racemosa on the right thigh. histology revealed medial calcification of the small arteries typical of calciphylaxis. We found the typical features of the disease with different risk factors like elevated calcium-phosphate product, diabetes mellitus and oral anticoagulation. On account of the location of the skin lesions, a bad prognosis was expected. In spite of therapeutical measures with lowering of the calcium and phosphate levels, the patient died 1 month after the diagnosis had been made.- - - - - - - - - - ranking = 1keywords = livedo (Clic here for more details about this article) |
2/8. Perinuclear antineutrophilic cytoplasmic antibody-positive cutaneous polyarteritis nodosa associated with minocycline therapy for acne vulgaris.minocycline is an oral antibiotic widely used for the long-term treatment of acne vulgaris. Unusual side effects of this medication include two overlapping autoimmune syndromes: drug-induced lupus and autoimmune hepatitis. In addition, in a few patients livedo reticularis or subcutaneous nodules have developed in association with arthritis and serum perinuclear antineutrophil cytoplasmic antibodies (P-ANCA) during long-term minocycline therapy. We report the cases of two young women receiving long-term minocycline therapy (>3 years) in whom P-ANCA-positive cutaneous polyarteritis nodosa developed. Both patients presented with a violaceous reticulated pattern on the lower extremities. Histologic examination of biopsy specimens from a reticulated area and a subcutaneous nodule showed necrotizing vasculitis of medium-sized arteries in the deep dermis, consistent with the diagnosis of polyarteritis nodosa. The cutaneous lesions rapidly resolved on discontinuation of minocycline and initiation of prednisone therapy. A high index of suspicion and testing for antineutrophil cytoplasmic antibody in addition to the standard antinuclear antibody panel can facilitate diagnosis of minocycline-related autoimmune disorders.- - - - - - - - - - ranking = 10.291891871559keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
3/8. Response of livedoid vasculitis to intravenous immunoglobulin.Livedoid vasculitis is a chronic condition characterized by recurrent painful ulceration of the lower limbs, which heals to leave atrophie blanche surrounded by hyperpigmentation and telangiectasia. We report two patients with livedoid vasculitis who, after failure of conventional therapies, responded to intravenous immunoglobulin (IVIg). There was healing of areas of active ulceration and improvement of erythema, swelling and pain. IVIg has been used successfully to treat a variety of vasculitic disorders and appears to be well tolerated. We suggest that this treatment is offered to patients who have livedoid vasculitis that is unresponsive to other therapies.- - - - - - - - - - ranking = 6keywords = livedo (Clic here for more details about this article) |
4/8. minocycline-induced cutaneous polyarteritis nodosa with antineutrophil cytoplasmic antibodies.minocycline is an antibiotic widely used in the treatment of acne. Among the induced auto-immune disorders, cutaneous polyarteritis nodosa (PAN) is very rare. A new case is reported below. A 23-year-old female patient treated with minocycline for acne for 24 months developed sub-cutaneous nodules, livedo reticularis and pigmented lesions of the lower limbs. Antineutrophil cytoplasmic antibodies (ANCA) were positive at 1/320. skin biopsy showed vasculitis of a medium-sized artery. The role of minocycline was suspected using the imputability criteria. The diagnosis of minocycline-induced cutaneous PAN with ANCA was sustained. After withdrawal of the treatment, the nodular lesions decreased spontaneously, whereas livedo disappeared and inflammatory parameters were normalized after oral corticosteroid therapy. minocycline is a tetracycline which is efficient for treating acne. Auto-immune disorders are frequently observed. Among them, it is very rare to observe cutaneous PAN associated with positive ANCA. The pathophysiological mechanisms are discussed.- - - - - - - - - - ranking = 11.291891871559keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
5/8. Cutaneous crystal cholesterol emboli.One case of cutaneous cholesterol emboli is described. In patients affected with severe arteriosclerosis of the abdominal aorta, cholesterol crystals may become detached from an atheromatous plaque and result in micro emboli ensuing skin lesions (livedo reticularis, nodules, purple toes, ulcerations, distal gangrene) on the lower extremities. Histopathologic study is required for diagnosis: the lumens of the arterioles were extensively occluded by macrophagic granuloma which surrounded cholesterol crystals.- - - - - - - - - - ranking = 10.291891871559keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
6/8. Fatal cutaneous necrosis mimicking calciphylaxis in a patient with type 1 primary hyperoxaluria.BACKGROUND: Cutaneous necrosis of the proximal lower extremities in a patient with end-stage renal disease is the classic presentation of calciphylaxis, an untreatable, rare, generally fatal necrotizing cutaneous syndrome. Type 1 primary hyperoxaluria (PH-1) usually presents in childhood with recurrent urolithiasis. Since enzymatic studies to confirm the metabolic defect are now available, some cases of idiopathic renal failure in adulthood have been shown to be caused by PH-1. These patients may develop vascular oxalate deposits resulting in livedo reticularis and distal acral vascular insufficiency. OBSERVATIONS: We describe a patient who presented in end-stage renal failure with proximal lower extremity cutaneous necrosis suggestive of calciphylaxis. A cutaneous biopsy specimen revealed oxalate crystals within blood vessels, and a diagnosis of PH-1 was confirmed enzymatically. CONCLUSIONS: This patient illustrates that PH-1 may present in adulthood, and, in the setting of cutaneous necrosis associated with end-stage renal disease, it may be confused with calciphylaxis. The importance of making a diagnosis of PH-1 is the potential ability to achieve long-term survival by reversing the underlying metabolic defect with hepatic transplantation.- - - - - - - - - - ranking = 10.291891871559keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
7/8. Reticulate purpura, cryoglobulinaemia and livedo reticularis.Two patients with type I cryoglobulinaemia are described, both of whom presented with purpura in a reticulate distribution on the legs, resembling the pattern of physiological livedo. It appeared that increased cooling due to sluggish blood flow in areas of the skin corresponding to the blue areas of physiological livedo may have caused the localization of cryoprecipitate at these sites. To investigate the pathogenesis of the net-like pattern of purpura, three subjects with physiological livedo reticularis of the thighs were studied with a laser-Doppler velocimeter. In two subjects, mean blood flux in the blue areas was 21% (P < 0.01) and 26% (P < 0.02) lower than in adjacent white areas, whereas in the third there was no significant difference. The cutaneous features of cryoglobulinaemia, and the mechanism of the reticulate purpura in this condition, are discussed.- - - - - - - - - - ranking = 53.459459357793keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |
8/8. livedo reticularis and nodules due to cholesterol embolism in the lower extremities.A case is described of livedo reticularis and nodules, resembling polyarteritis nodosa but shown to be due to emboli of cholesterol crystals.- - - - - - - - - - ranking = 18.601081404788keywords = livedo reticularis, reticularis, livedo (Clic here for more details about this article) |