Livedo of the Forearm in the Aftermath of Forearm Erysipelas

Livedo is an ischemic dermopathy caused by vasculopathies or prothrombotic states, and characterized by the violaceous lace-like mottling of the skin. We report on a patient who developed livedo reticularis – livedo racemosa overlap syndrome as a late sequel of erysipelas, the livedo being restricted to the limb segment affected earlier by erysipelas and devoid of systemic vasculopathy. Though erysipelas and livedo are common disorders, we could not find in the literature reports of an occurrence like that observed in this patient. In this case a favorable prognosis of livedo could be predicted. In a different context, livedo may be the alarming signal of an undiagnosed systemic disease.

LIVEDO RETICULARIS: CLINICAL SIGNIFICANCE AND TREATMENT

Livedo reticularis (LR) is a hyperpigmented discoloration of the skin characterized by a violet, reticulated cyanotic pattern, and is more common on the extremities and trunk. LR is in the form of intact circular networks. If the circular reticulated appearance is distorted and shows an irregular fracture pattern, it is defined as livedo racemosa (LRC). LR is a benign, primary disease that affects young and middle-aged women. LRC, on the other hand, is a secondary disease, pathological and permanent. In LR, the vivid cone discoloration is symmetrical, reversible, and uniform. In LRC, the vivid cone discoloration is irreversible, and fractured. Although it has been stated as a concept that the pathological livedoid form is LCR, there is no clear distinction between LR and LRC in clinical studies and generally 'livedo reticularis' is used to describe both. Our study includes eight patients diagnosed with livedo reticularis between January 2013 and May 2021. One of our patients was male and the other was female. Their ages ranged from 25 to 70 years and the mean age was 45.5±16.7 years. Although the main complaints were coldness, numbness and pain, aesthetic anxiety was prominent in all patients. On physical examination, violet-colored fishing net-like appearances were noted on the lower extremities of all patients. It was accompanied by venous insufficiency in six of the patients. As a result of the treatment we applied, there was improvement in venous insufficiency. However, as a result of the vasodilator treatment we applied for cosmological purposes, there was no obvious improvement in the reticulated appearances. Because of the risk of developing neurovascular and cardiovascular complications several years after the onset of livedoid vasculopathy, it is important to monitor these patients. Considering that LR may be seen before pulmonary symptoms during the COVID-19 pandemic period, necessary tests should be performed to rule out the diagnosis of COVID-19 in these cases.

Primary Antiphospholipid Syndrome with Livedo Reticularis is Linked to Female Sex and Stroke and Negatively Associated with Thyroid Disease

Aim: To study the clinical and laboratory findings between patients with primary Antiphospholipid Syndrome (pAPS) with and without LR. Background: Livedo Reticularis (LR) is a common manifestation of Antiphospholipid Syndrome (APS). Although no previous study evaluated patients with and without LR. Methods: A transversal study including 66 pAPS patients was performed. Demographical, anthropometric, medication use, antiphospholipid antibodies profile data were evaluated, and LR's clinical and laboratory features. Patients were subdivided into one of two groups: pAPS with LR and pAPS without LR. Results: Both groups were alike concerning demographics and anthropometrics. Interestingly, the frequency of stroke (28.5 vs. 7.5%, p=0.04), as well as of Sneddon’s syndrome (100 vs. 30.0%, p<0.0001), were higher in pAPS with LR than the other group. Conversely, patients in the pAPS without LR group had more thyroidopathy than those in the pAPS with LR group (80% vs. 50% %, p=0.03). Conclusion: Patients with pAPS and LR have more stroke and seem to be protected from thyroidopathy. Careful follow-up of these patients is therefore advised.

Lupus-related vasculitis in a cohort of systemic lupus erythematosus patients

Objectives: This study aims to examine the frequency and clinical association of lupus-related vasculitis in patients with systemic lupus erythematosus (SLE). Patients and methods: We retrospectively analyzed medical records of a total of 565 SLE patients (42 males, 523 females; mean age: 32.7±9.5 years; range, 13 to 63 years) between January 2017 and February 2020. Demographic, clinical data, and laboratory data and treatment modalities applied were recorded. Lupus-related vasculitis and its different types were documented, and the patients with vasculitis were compared with those without vasculitis. Results: The mean disease duration was 8.9±6.3 years. Vasculitis associated with lupus was found in 191 (33.45%) patients. Cutaneous vasculitis was found in 59.2%, visceral vasculitis in 34.0%, and both in 6.8% of total vasculitis patients. The patients with vasculitis had a longer disease duration (p=0.01), were more likely to have juvenile onset (p=0.002), livedo reticularis (p<0.001), Raynaud's phenomenon (RP) (p<0.001), digital gangrene (p<0.001), thrombosis (p=0.003), and cranial neuropathy (p=0.004). The patients with vasculitis showed a higher prevalence of hypercholesterolemia (p=0.045), diabetes mellitus (p=0.026), higher Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) at disease onset (p<0.001), and Systemic Lupus International Collaborating Clinics (SLICC) Damage Index (p=0.003) scores. They had more prevalent hematological manifestations (p<0.001), hypocomplementemia (p=0.007), received a higher cumulative dose of intravenous methylprednisolone (p<0.001), and had also more frequent cyclophosphamide (p=0.016) and azathioprine intake (p<0.001). In the logistic regression analysis, SLE vasculitis was independently associated with juvenile disease onset, livedo reticularis, RP, hematological manifestations, and higher scores of SLEDAI at disease onset (p<0.05). Conclusion: Juvenile disease onset, livedo reticularis, RP, hematological manifestations, and higher SLEDAI scores at disease onset may be associated with the development of vasculitis in SLE patients.

Lesiones dermatológicas en pediatría por infección SARS-CoV-2

Desde diciembre de 2019 el mundo se ha visto afectado por una pandemia causada por el virus SARS-CoV-2, causante de la enfermedad COVID-19, conocida por su gran capacidad infecciosa y rápida transmisión. Este virus se transmite por contacto de persona a persona y a través de secreciones de personas infectadas, principalmente gotitas respiratorias. Desde el inicio de la pandemia se conoce que los niños, niñas y adolescentes tienen un menor riesgo de enfermarse y de morir por COVID-19 que otros grupos etarios. Las manifestaciones clínicas de la COVID-19 son múltiples y variadas, y son muy parecidas a las del resfriado común. Últimamente se han descrito lesiones cutáneas inespecíficas, más frecuentemente en niños y adolescentes, a veces como único síntoma clínico o en el contexto del cuadro típico de la infección. Entre las manifestaciones cutáneas registradas en pacientes con COVID-19 incluyen, exantemas urticarianos, morbiliformes, vesiculares y petequiales, así como manifestaciones vasoespásticas como livedo reticularis, lesiones isquémicas acrales y lesiones cutáneas en los dedos de los pies y manos idénticas a los sabañones. El tratamiento es sintomático, pudiendo manejarse con corticoides tópicos, antihistamínicos en el caso de prurito moderado, y antibióticos tópicos para evitar sobreinfecciones en las lesiones acroisquémicas. El enfoque general del presente trabajo es dar a conocer las principales lesiones dermatológicas ocasionadas por la infección SARS-CoV-2 en pacientes pediátricos, sus características, síntomas y tratamientos. Los resultados se obtuvieron mediante el desarrollo de una investigación de tipo bibliográfica, delimitada a una metodología de revisión, que permite concluir que aun y cuando este tipo de lesiones no representan una amenaza grave para los pacientes, se recomienda conocer la sintomatología de las mismas para así aplicar las medidas preventivas y de tratamiento que eviten posibles complicaciones.

AB0308 COGNITIVE IMPAIRMENT IN SYSTEMIC LUPUS ERYTHEMATOSUS AND ANTIPHOSPHOLIPID SYNDROME PATIENTS

Background:Cognitive impairment (CI) in systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) patients have been poorly described and recognized.Objectives:to describe the rates and spectrum of CI in primary (PAPS) and secondary to systemic lupus erythematosus (SLE) (SAPS) APS patientsMethods:113 patients (70 with APS (37 – PAPS, 33 – SAPS) and 43 - SLE without APS), 89 (78,8%) – women, were consecutively enrolled in the study. The mean (M±SD) age was 37,9±11,9 years. SLE activity was measured by SLEDAI scale. Mental disorders (MD) were diagnosed by psychiatrist in accordance with ICI-10 in semi-structured interview. CI were diagnosed with psychology and neuropsychology methodsResults:CI of varying severity were found in 105 (92,9%) patients: 62,9% - mild, 23,8% - moderate and 13,3% - severe. Severe and moderate CI were more associated with APS (48,6% in PAPS and 39,5% in SAPS vs 18,6% in SLE, p=0,004 and p=0,04, accordingly). CI were predominantly organic origin in all patients, but vascular dementia was detected only among patients with APS (10,8% of PAPS and 3,03% of SAPS patients). There was no association of CI with clinical manifestations and SLE activity. In patients with PAPS CI was associated with stroke, livedo reticularis and lupus anticoagulant positivity. In 84 patients (74,3%) CI were also specifically bounded to MD. Current MD were detected in 100 (88,5%) patients: schizotypal disorder was found in 10 (8,85%) patients and was associated with PAPS (13,5% vs 9,09% in SAPS and 4,65% in SLE); anxiety-depressive spectrum disorders (ADDs) - in 95 (84,1%) (chronic and recurrent depression prevailed 37 (32,7%) and 42 (37,2%) resp.); the structure of MDs in accordance with ICI-10 differed slightly between groups, but no statistically significant differences were obtained.Conclusion:сognitive impairment, mainly of an organic type, are characteristic of most patients with SLE and APS. The significant associations of сognitive impairment with clinical manifestations and activity of SLE were not identified, but patients with сognitive impairments were more likely to have anxiety and depressive disorders, strokes, livedo reticularis and lupus anticoagulant positivityDisclosure of Interests:None declared