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Year : 1996  |  Volume : 62  |  Issue : 4  |  Page : 258-259

Livedo reticularis with acute rheumatic fever

Correspondence Address:
Puneet Bhargava

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Source of Support: None, Conflict of Interest: None

PMID: 20948073

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A 10-year-old boy, a diagnosed case of acute rheumatic fever, presented with livedo reticularis involving whole of body except face. Livedo reticularis has been very rarely reported in rheumatic fever.

Keywords: Livedo reticularis, Rheumatic fever

How to cite this article:
Bhargava P, Kuldeep C M, Mathur N K. Livedo reticularis with acute rheumatic fever. Indian J Dermatol Venereol Leprol 1996;62:258-9

How to cite this URL:
Bhargava P, Kuldeep C M, Mathur N K. Livedo reticularis with acute rheumatic fever. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2019 Aug 21];62:258-9. Available from: http://www.ijdvl.com/text.asp?1996/62/4/258/4410

  Introduction Top

Livedo reticularis is a mottled bluish (livid) discolouration of the skin which occurs in a net like pattern. This discolouration seen mainly in young women of less than 40 years is persistent and may change from reddish blue in a warm environment to deep blue in cold environment.[1] It has been suggested that this net like pattern is due to venous drainage at the margins of areas of skin richly supplied by arterial cones.

This pattern may result from arteriolar disease causing obstruction to inflow from blood, hyperviscosity or from obstruction to outflow of blood in the venules,[2] leading to deoxygenation of blood and cyanotic reticular pattern. We report a case of livedo reticularis occurring with acute rheumatic fever.

  Case Report Top

A 10-year-old Hindu boy presented with complaints of reticular reddish-blue mottling of the skin all over the body except the face for 15 days. He was a diagnosed case of acute rheumatic fever having carditis (mitral, regurgitation / tricuspid regurgitation), polyarthritis, fever, increased PR interval and raised ASLO titres and C-reactive protein. Personal history didn't suggest any familial trait or drug reaction. SLE, polyarteritis nodosa (PAN) and cryoglobinemia were excluded by clinical examination and laboratory tests. Dermatological examination revealed benign generalised livedo reticularis [Figure - 1].

  Discussion Top

Secondary livedo reticularis is often a cutaneous manifestation of collagen disorders especially SLE, PAN, rheumatoid arthritis and dermatomyositis.[1] Circulating immune complexes, defect in fibrinolytic system, abnormal platelet adhesiveness and other blood or tissue abnormalities are often noticed in these collagen vascular disorders, which may be associated with the pathogenesis of livedo reticularis.[3] Histopathologically immune complexes containing IgA, IgM, complement factors and fibrin have been found in blood vessel walls in these patients.[4] These changes in SLE and secondary syphilis have been reported to be due to high titre of anticardiolipin antibodies.[5] Livedo reticularis has been very rarely reported in acute rheumatic fever.[6] Rheumatic fever is associated with activation of multiple clones of autoantibodies. It may be possible that autoantibodies found in rheumatic fever may be involved in pathogenesis of livedo reticularis.

  References Top

1.Shear NH, Page EH. Disorders due to physical factors. In: Fitzpatrick TB, Eisen AZ, Wolff K, editors. Dermatology in general medicine. New york: McGraw-Hill, 1993:1584-5.  Back to cited text no. 1    
2.Copeman PWM. Livedo reticularis. Br J Dermatol 1975;93:519.  Back to cited text no. 2    
3.Cunliffe WJ, Menon IS. The association between cutaneous vasculitis and decreased blood fibrinolytic activity. Br J Dermatol 1971;84:99.  Back to cited text no. 3  [PUBMED]  
4.Winkelmann RK, et al. Clinical studies of livedoid vasculitis (segmental hyalinizing vasculitis). Mayo Clin Proc 1974;49:746.  Back to cited text no. 4  [PUBMED]  
5.Weinstein C, et al. Livedo reticularis associated with increased titres of anticardiolipin antibodies in systemic lupus erythematous. Arch Dermatol 1987;123:596.  Back to cited text no. 5  [PUBMED]  
6.Haber H. Zur Atiologie der livedo racemosa. Arch Dermatol Syphilol 1931;163:1.  Back to cited text no. 6    


[Figure - 1]


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