Livedoid vasculopathy associated with peripheral neuropathy: a report of two cases

Livedoid vasculopathy (LV) is a chronic and recurrent disease consisting of livedo reticularis and symmetric ulcerations, primarily located on the lower extremities, which heal slowly and leave an atrophic white scar ("atrophie blanche"). Neurological involvment is rare and presumed to be...

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Published in:	Anais brasileiros de dermatología Vol. 88; no. 6 Suppl 1; pp. 227 - 229
Main Authors:	Tubone, Mariana Quirino, Escobar, Gabriela Fortes, Peruzzo, Juliano, Schestatsky, Pedro, Maldonado, Gabriela
Format:	Journal Article
Language:	English
Published:	Spain Sociedade Brasileira de Dermatologia 01-12-2013
Subjects:	Biopsy Case Report DERMATOLOGY Diagnosis, Differential Female Humans Livedo reticularis Livedo Reticularis - complications Livedo Reticularis - pathology Middle Aged Mononeuropathies Peripheral Nervous System Diseases - complications Peripheral Nervous System Diseases - pathology Polyneuropathies Skin diseases, vascular Skin Ulcer - pathology Skin diseases, vascular Livedo reticular Mononeuropathies Polyneuropathies Mononeuropatias Livedo reticularis Dermatopatias vasculares Polineuropatias
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Abstract	Livedoid vasculopathy (LV) is a chronic and recurrent disease consisting of livedo reticularis and symmetric ulcerations, primarily located on the lower extremities, which heal slowly and leave an atrophic white scar ("atrophie blanche"). Neurological involvment is rare and presumed to be secondary to the ischemia from vascular thrombosis of the vasa nervorum. Laboratory evaluation is needed to exclude secondary causes such as hyper-coagulable states, autoimmune disorders and neoplasms. We present two patients with a rare association of peripheral neuropathy and LV, thereby highlighting the importance of a multidisciplinary approach to reach the correct diagnosis.
AbstractList	Livedoid vasculopathy (LV) is a chronic and recurrent disease consisting of livedo reticularis and symmetric ulcerations, primarily located on the lower extremities, which heal slowly and leave an atrophic white scar ("atrophie blanche"). Neurological involvment is rare and presumed to be secondary to the ischemia from vascular thrombosis of the vasa nervorum. Laboratory evaluation is needed to exclude secondary causes such as hyper-coagulable states, autoimmune disorders and neoplasms. We present two patients with a rare association of peripheral neuropathy and LV, thereby highlighting the importance of a multidisciplinary approach to reach the correct diagnosis. Livedoid vasculopathy (LV) is a chronic and recurrent disease consisting of livedo reticularis and symmetric ulcerations, primarily located on the lower extremities, which heal slowly and leave an atrophic white scar ("atrophie blanche"). Neurological involvment is rare and presumed to be secondary to the ischemia from vascular thrombosis of the vasa nervorum. Laboratory evaluation is needed to exclude secondary causes such as hyper-coagulable states, autoimmune disorders and neoplasms. We present two patients with a rare association of peripheral neuropathy and LV, thereby highlighting the importance of a multidisciplinary approach to reach the correct diagnosis. Vasculopatia livedoide é uma doença crônica e recorrente caracterizada por livedo reticular e úlceras simétricas nos membros inferiores, que cicatrizam e deixam uma cicatriz branca atrófica ("atrophie blanche"). Envolvimento neurológico é raro e está provavelmente associado a isquemia pela trombose dos vasa nervorum. Avaliação laboratorial é indicada com o intuito de excluir causas secundárias como estados de hipercoagulabilidade, doenças autoimunes e neoplasias. Apresentamos dois pacientes com uma rara associação de vasculopatia livedoide com neuropatia periférica, enfatizando a importância de uma abordagem multidisciplinar na busca do diagnóstico correto. Livedoid vasculopathy (LV) is a chronic and recurrent disease consisting of livedo reticularis and symmetric ulcerations, primarily located on the lower extremities, which heal slowly and leave an atrophic white scar ("atrophie blanche"). Neurological involvment is rare and presumed to be secondary to the ischemia from vascular thrombosis of the vasa nervorum. Laboratory evaluation is needed to exclude secondary causes such as hyper-coagulable states, autoimmune disorders and neoplasms. We present two patients with a rare association of peripheral neuropathy and LV, thereby highlighting the importance of a multidisciplinary approach to reach the correct diagnosis.
Author	Tubone, Mariana Quirino Escobar, Gabriela Fortes Schestatsky, Pedro Maldonado, Gabriela Peruzzo, Juliano
AuthorAffiliation	3 MSc in Medical Sciences - Dermatology from the Federal University of Rio Grande do Sul - Preceptor at Dermatology Service of the Hospital de Clínicas de Porto Alegre - Federal University of Rio Grande do Sul (HCPA - UFRGS) - Porto Alegre (RS), Brazil 1 Medical Resident at the Dermatology Service of the Hospital de Clínicas de Porto Alegre - Federal University of Rio Grande do Sul (HCPA - UFRGS) - Porto Alegre (RS), Brazil 2 PhD from the Federal University of Rio Grande do Sul (UFRGS) - Adjunct Professor of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS) - Porto Alegre (RS), Brazil
AuthorAffiliation_xml	– name: 1 Medical Resident at the Dermatology Service of the Hospital de Clínicas de Porto Alegre - Federal University of Rio Grande do Sul (HCPA - UFRGS) - Porto Alegre (RS), Brazil – name: 2 PhD from the Federal University of Rio Grande do Sul (UFRGS) - Adjunct Professor of Internal Medicine, Federal University of Rio Grande do Sul (UFRGS) - Porto Alegre (RS), Brazil – name: 3 MSc in Medical Sciences - Dermatology from the Federal University of Rio Grande do Sul - Preceptor at Dermatology Service of the Hospital de Clínicas de Porto Alegre - Federal University of Rio Grande do Sul (HCPA - UFRGS) - Porto Alegre (RS), Brazil – name: Universidade Federal do Rio Grande do Sul
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Cites_doi	10.1002/mus.10450 10.1046/j.1365-4362.2001.01183.x 10.1046/j.1365-2133.2003.05176.x 10.1001/archderm.142.11.1413 10.1111/j.1346-8138.2009.00754.x 10.3988/jcn.2011.7.4.233 10.1001/archderm.142.1.75
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Keywords	Skin diseases, vascular Livedo reticular Mononeuropathies Polyneuropathies Mononeuropatias Livedo reticularis Dermatopatias vasculares Polineuropatias
Language	English
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References	Criado PR (ref2) 2011; 86 Khenifer S (ref5) 2009; 34 Mimouni D (ref8) 2003; 148 Kim JE (ref7) 2011; 7 Lee JH (ref9) 2001; 40 Hairston BR (ref1) 2006; 142 Osada S (ref6) 2010; 37 Browning CE (ref3) 2006; 142 Toth C (ref4) 2003; 28 Osada, S; Kimura, Y; Kawana, S 2010; 37 Khenifer, S; Thomas, L; Balme, B; Dalle, S 2009; 34 Hairston, BR; Davis, MD; Pittelkow, MR; Ahmed, I 2006; 142 Browning, CE; Callen, JP 2006; 142 Lee, JH; Choi, HJ; Kim, SM; Hann, SK; Park, YK 2001; 40 Criado, PR; Rivitti, EA; Sotto, MN; Valente, NY; Aoki, V; Carvalho, JF 2011; 86 Toth, C; Trotter, M; Clark, A; Zochodne, D 2003; 28 Mimouni, D; Ng, PP; Rencic, A; Nikolskaia, OV; Bernstein, BD; Nousari, HC 2003; 148 Kim, JE; Park, SY; Sinn, DI; Kim, SM; Hong, YH; Park, KS 2011; 7
References_xml	– volume: 28 start-page: 634 year: 2003 ident: ref4 article-title: Mononeuropathy multiplex in association with livedoid vasculitis publication-title: Muscle Nerve doi: 10.1002/mus.10450 contributor: fullname: Toth C – volume: 40 start-page: 153 year: 2001 ident: ref9 article-title: Livedoid vasculitis responding to PUVA therapy publication-title: Int J Dermatol doi: 10.1046/j.1365-4362.2001.01183.x contributor: fullname: Lee JH – volume: 148 start-page: 789 year: 2003 ident: ref8 article-title: Cutaneous polyarteritis nodosa in patients presenting with atrophie blanche publication-title: Br J Dermatol doi: 10.1046/j.1365-2133.2003.05176.x contributor: fullname: Mimouni D – volume: 34 start-page: e811 year: 2009 ident: ref5 article-title: Livedoid vasculopathy thrombotic or Inflammatory disease? publication-title: Clin Exp Dermatol contributor: fullname: Khenifer S – volume: 142 start-page: 1413 year: 2006 ident: ref1 article-title: Livedoid vasculopathyfurther evidence for procoagulant pathogenesis publication-title: Arch Dermatol doi: 10.1001/archderm.142.11.1413 contributor: fullname: Hairston BR – volume: 37 start-page: 98 year: 2010 ident: ref6 article-title: Case of livedoid vasculopathy with peripheral neuropathy successfully treated with low-dose warfarin publication-title: J Dermatol doi: 10.1111/j.1346-8138.2009.00754.x contributor: fullname: Osada S – volume: 7 start-page: 233 year: 2011 ident: ref7 article-title: Ischemic neuropathy associated with livedoid vasculitis publication-title: J Clin Neurol doi: 10.3988/jcn.2011.7.4.233 contributor: fullname: Kim JE – volume: 142 start-page: 75 year: 2006 ident: ref3 article-title: Warfarin therapy for livedoid vasculopathy associated with cryofibrinogenemia and hyperhomocysteinemia publication-title: Arch Dermatol doi: 10.1001/archderm.142.1.75 contributor: fullname: Browning CE – volume: 86 start-page: 961 year: 2011 ident: ref2 article-title: Livedoid vasculopathyan intringuing cutaneous disease publication-title: An Bras Dermatol contributor: fullname: Criado PR – volume: 40 start-page: 153 year: 2001 end-page: 157 article-title: Livedoid vasculitis responding to PUVA therapy publication-title: Int J Dermatol contributor: fullname: Lee, JH; Choi, HJ; Kim, SM; Hann, SK; Park, YK – volume: 148 start-page: 789 year: 2003 end-page: 794 article-title: Cutaneous polyarteritis nodosa in patients presenting with atrophie blanche publication-title: Br J Dermatol contributor: fullname: Mimouni, D; Ng, PP; Rencic, A; Nikolskaia, OV; Bernstein, BD; Nousari, HC – volume: 34 start-page: e811 year: 2009 end-page: e813 article-title: Livedoid vasculopathy thrombotic or Inflammatory disease? publication-title: Clin Exp Dermatol contributor: fullname: Khenifer, S; Thomas, L; Balme, B; Dalle, S – volume: 7 start-page: 233 year: 2011 end-page: 236 article-title: Ischemic neuropathy associated with livedoid vasculitis publication-title: J Clin Neurol contributor: fullname: Kim, JE; Park, SY; Sinn, DI; Kim, SM; Hong, YH; Park, KS – volume: 142 start-page: 1413 year: 2006 end-page: 1418 article-title: Livedoid vasculopathyfurther evidence for procoagulant pathogenesis publication-title: Arch Dermatol contributor: fullname: Hairston, BR; Davis, MD; Pittelkow, MR; Ahmed, I – volume: 86 start-page: 961 year: 2011 end-page: 977 article-title: Livedoid vasculopathyan intringuing cutaneous disease publication-title: An Bras Dermatol contributor: fullname: Criado, PR; Rivitti, EA; Sotto, MN; Valente, NY; Aoki, V; Carvalho, JF – volume: 37 start-page: 98 year: 2010 end-page: 101 article-title: Case of livedoid vasculopathy with peripheral neuropathy successfully treated with low-dose warfarin publication-title: J Dermatol contributor: fullname: Osada, S; Kimura, Y; Kawana, S – volume: 142 start-page: 75 year: 2006 end-page: 78 article-title: Warfarin therapy for livedoid vasculopathy associated with cryofibrinogenemia and hyperhomocysteinemia publication-title: Arch Dermatol contributor: fullname: Browning, CE; Callen, JP – volume: 28 start-page: 634 year: 2003 end-page: 639 article-title: Mononeuropathy multiplex in association with livedoid vasculitis publication-title: Muscle Nerve contributor: fullname: Toth, C; Trotter, M; Clark, A; Zochodne, D
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SubjectTerms	Biopsy Case Report DERMATOLOGY Diagnosis, Differential Female Humans Livedo reticularis Livedo Reticularis - complications Livedo Reticularis - pathology Middle Aged Mononeuropathies Peripheral Nervous System Diseases - complications Peripheral Nervous System Diseases - pathology Polyneuropathies Skin diseases, vascular Skin Ulcer - pathology
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Title	Livedoid vasculopathy associated with peripheral neuropathy: a report of two cases
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