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Gale A Mccarty - One of the best experts on this subject based on the ideXlab platform.
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The antiphospholipid antibody syndrome in the emergency department setting — Livedo reticularis and recurrent venous thrombosis
Annals of emergency medicine, 1992Co-Authors: Samar Kester, David L. Mccarty, Gale A MccartyAbstract:We present the case of a 26-year-old man with an exacerbation of apparent chronic asthma with chronic peripheral vascular disease due to recurrent venous thrombosis. Localized Livedo reticularis, new cutaneous infarctions, severe venous insufficiency, thrombocytopenia, renal failure, and cerebral supratentorial dysfunction were noted. During hospital admission, antibodies to phospholipids in high titer were present by three different testing methods. Renal biopsy demonstrated significant renal vasculature abnormalities characteristic of hemolytic endovasculopathy, and magnetic resonance imaging showed multiple cerebral infarctions. This case exemplifies the spectrum of presentations and management of the primary antiphospholipid antibody syndrome. The clue to its presence in this patient was the Livedo reticularis rash, a cutaneous marker for this syndrome that was evident in the emergency department.
Gretchen E Tietjen - One of the best experts on this subject based on the ideXlab platform.
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migraine is associated with Livedo reticularis a prospective study
Headache, 2002Co-Authors: Gretchen E Tietjen, Lorie Gottwald, Mohamed M Alqasmi, Padma Gunda, Sadik A KhuderAbstract:Objective.—To investigate the relationship of Livedo reticularis, an ischemic dermatopathy, and migraine, an ischemic stroke risk factor. Background.—Livedo reticularis refers to the reddish-blue reticular mottling of the skin resulting from narrowing of small and medium arteries at the dermis-subcutis border. A subset of patients with Livedo reticularis develop stroke in the absence of other vascular risk factors, which has been termed Sneddon syndrome. We undertook this prospective study in a non-neurology clinic to delineate further the relationship of Livedo reticularis and migraine. Methods.—Patients in a general dermatology clinic were interviewed for vascular risk factors and history of migraine in accordance with the International Headache Society (IHS) criteria. A dermatologist, not familiar with the interview, recorded the primary dermatological diagnosis and the presence or absence of Livedo reticularis on examination. Results.—Two hundred eighty-one consecutive patients (184 women and 97 men; average age, 52 years) were interviewed and examined. Seventy-five (27%) had migraine (IHS codes 1.1, 1.2) and an additional 18 (6%) had atypical migraine (IHS 1.7). Livedo reticularis was noted in 46 patients (16%), with the frequency higher in women than men (42 [23%] of 184 versus 4 [4%] of 97; P < .0001). The frequency of Livedo reticularis in patients with migraine was higher than in those without migraine (24 [26%] of 93 versus 22 [12%] of 188; P = .002), and higher in female than male migraineurs (23 [32%] of 72 versus 1 [5%] of 21; P = .012). In logistic regression analysis of the women, migraine was associated with Livedo reticularis (odds ratio [OR], 2.3; confidence interval [CI], 1.08 to 4.71), as well as with stroke (OR, 4.0; CI, 0.87 to 18.21), coronary artery disease (OR, 3.5; CI, 1.16 to 10.33), and deep venous thrombosis (OR, 3.2; CI, 0.98 to 10.32). Conclusions.—In women, migraine is associated with stroke, coronary artery disease, deep venous thrombosis, as well as Livedo reticularis, a dermatopathy which has been pathologically linked to cerebral vasculopathy. Whether migraineurs with Livedo reticularis compose a subset at higher risk of thrombosis, including stroke, deserves further investigation.
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Migraine Is Associated With Livedo reticularis: A Prospective Study
Headache, 2002Co-Authors: Gretchen E Tietjen, Lorie Gottwald, Padma Gunda, Mohamed M. Al‐qasmi, Sadik A KhuderAbstract:Objective.—To investigate the relationship of Livedo reticularis, an ischemic dermatopathy, and migraine, an ischemic stroke risk factor. Background.—Livedo reticularis refers to the reddish-blue reticular mottling of the skin resulting from narrowing of small and medium arteries at the dermis-subcutis border. A subset of patients with Livedo reticularis develop stroke in the absence of other vascular risk factors, which has been termed Sneddon syndrome. We undertook this prospective study in a non-neurology clinic to delineate further the relationship of Livedo reticularis and migraine. Methods.—Patients in a general dermatology clinic were interviewed for vascular risk factors and history of migraine in accordance with the International Headache Society (IHS) criteria. A dermatologist, not familiar with the interview, recorded the primary dermatological diagnosis and the presence or absence of Livedo reticularis on examination. Results.—Two hundred eighty-one consecutive patients (184 women and 97 men; average age, 52 years) were interviewed and examined. Seventy-five (27%) had migraine (IHS codes 1.1, 1.2) and an additional 18 (6%) had atypical migraine (IHS 1.7). Livedo reticularis was noted in 46 patients (16%), with the frequency higher in women than men (42 [23%] of 184 versus 4 [4%] of 97; P
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Livedo reticularis and migraine: a marker for stroke risk?
Headache, 2002Co-Authors: Gretchen E Tietjen, Mohamed M. Al‐qasmi, Mohammad S. ShukairyAbstract:Background and Purpose.—Livedo reticularis is a dermatopathy characterized by an irregular, violaceous, netlike pattern which spares the face. Associated with a variety of conditions, it occurs consequent to pathological or physiological narrowing of small and medium arteries at the dermis-subcutis border. Sneddon syndrome refers to the idiopathic coupling of Livedo reticularis and stroke in the absence of traditional vascular risk factors. Over 50% of persons with Sneddon syndrome describe a history of headache. We undertook this study to determine the frequency of Livedo reticularis in our headache clinic. Methods.—We performed a retrospective chart review of consecutive patients attending a headache clinic over a period of 6 months. The patients had all been seen by one physician (G.E.T.) who noted the presence or absence of Livedo reticularis. The charts were reviewed for age, sex, and vascular risk factors, including current use of oral contraceptives, and history of smoking, coronary artery disease, hypertension, diabetes mellitus, stroke, or arthritis. Results.—Charts from 133 patients with headache were reviewed (24 men [18%], 109 women [82%]; mean age, 42 ± 13 years). Livedo reticularis was observed in 29 patients (22%) and in a similar proportion in men (25%) and women (21%). When we stratified the migraine population by presence or absence of Livedo, we found no significant difference in age (44.5 versus 41.7 years, P = .16). There was a higher frequency of stroke diagnosis in the cohort with Livedo reticularis (28%[8 of 29] versus 7%[7 of 104], P = .005), but we found no significant differences in frequency of hypertension, oral contraceptive use, diabetes mellitus, coronary artery disease, arthritis, or cigarette smoking. Conclusions.—In our headache clinic, Livedo reticularis is present in more than one fifth of patients. A history of stroke is more frequent in this subset of migraineurs, raising the possibility that Livedo reticularis can be used as a clinical marker to identify those migraineurs with an increased risk of stroke.
Yoshinao Soma - One of the best experts on this subject based on the ideXlab platform.
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Differences in anti-phosphatidylserine–prothrombin complex antibodies and cutaneous vasculitis between regular Livedo reticularis and Livedo racemosa
Rheumatology (Oxford England), 2009Co-Authors: Tamihiro Kawakami, Masahide Yamazaki, Masako Mizoguchi, Yoshinao SomaAbstract:OBJECTIVES We examined the prevalence of LAC, aCL antibodies (Abs), anti-beta(2)-glycoprotein I (anti-beta(2)GPI) Abs and anti-phosphatidylserine-prothrombin complex (anti-PS/PT) Abs in patients with regular Livedo reticularis or with Livedo racemosa to determine whether those Abs correlate with the clinical or serological features. Assuming that a correlation exists, early recognition of the serological features of the cutaneous manifestations may aid in the treatment and prediction of complications. METHODS We examined the prevalence of LAC, aCL Abs, anti-beta(2)GPI Abs and anti-PS/PT Abs in 143 Japanese patients who presented at our department with regular Livedo reticularis or Livedo racemosa between 2003 and 2008. LAC was determined according to the guidelines recommended by the Subcommittee on Lupus Anticoagulant/Phospholipid-Dependent Antibodies. Levels of anti-PS/PT, aCL and anti-beta(2)GPI Abs in serum samples taken from patients were measured by specific ELISAs. RESULTS Anti-PS/PT Abs were detected in 94 (65.7%) of the Livedo patients. Further, IgM anti-PS/PT Abs were detected in 90 (62.9%) of the Livedo patients. Serum IgM anti-PS/PT Ab levels were significantly higher in Livedo racemosa patients compared with regular Livedo reticularis (19.2 +/- 17.0 vs 8.93 +/- 8.48 U/ml, P = 0.0013). Cutaneous vasculitis was significantly more prevalent among patients with Livedo racemosa compared with regular Livedo reticularis (P = 0.0014). Livedo racemosa patients had significantly higher CRP serum levels than regular Livedo reticularis patients. Livedo racemosa has a stronger association with skin ulceration and arthralgia compared with regular Livedo reticularis. Overall, we found a statistically significant association between cutaneous vasculitis and ischaemic cerebrovascular events in our Livedo patients. CONCLUSIONS We speculate that IgM anti-PS/PT Abs could be implicated in disease susceptibility for Livedo racemosa. We further suspect that cutaneous vasculitis could be closely related to pathogenic factors that trigger the development of Livedo racemosa. Early detection of cutaneous vasculitis in skin biopsies of Livedo patients should be useful for prognostic evaluation, including ischaemic cerebrovascular events.
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differences in anti phosphatidylserine prothrombin complex antibodies and cutaneous vasculitis between regular Livedo reticularis and Livedo racemosa
Rheumatology, 2008Co-Authors: Tamihiro Kawakami, Masahide Yamazaki, Masako Mizoguchi, Yoshinao SomaAbstract:Objectives We examined the prevalence of LAC, aCL antibodies (Abs), anti-beta(2)-glycoprotein I (anti-beta(2)GPI) Abs and anti-phosphatidylserine-prothrombin complex (anti-PS/PT) Abs in patients with regular Livedo reticularis or with Livedo racemosa to determine whether those Abs correlate with the clinical or serological features. Assuming that a correlation exists, early recognition of the serological features of the cutaneous manifestations may aid in the treatment and prediction of complications. Methods We examined the prevalence of LAC, aCL Abs, anti-beta(2)GPI Abs and anti-PS/PT Abs in 143 Japanese patients who presented at our department with regular Livedo reticularis or Livedo racemosa between 2003 and 2008. LAC was determined according to the guidelines recommended by the Subcommittee on Lupus Anticoagulant/Phospholipid-Dependent Antibodies. Levels of anti-PS/PT, aCL and anti-beta(2)GPI Abs in serum samples taken from patients were measured by specific ELISAs. Results Anti-PS/PT Abs were detected in 94 (65.7%) of the Livedo patients. Further, IgM anti-PS/PT Abs were detected in 90 (62.9%) of the Livedo patients. Serum IgM anti-PS/PT Ab levels were significantly higher in Livedo racemosa patients compared with regular Livedo reticularis (19.2 +/- 17.0 vs 8.93 +/- 8.48 U/ml, P = 0.0013). Cutaneous vasculitis was significantly more prevalent among patients with Livedo racemosa compared with regular Livedo reticularis (P = 0.0014). Livedo racemosa patients had significantly higher CRP serum levels than regular Livedo reticularis patients. Livedo racemosa has a stronger association with skin ulceration and arthralgia compared with regular Livedo reticularis. Overall, we found a statistically significant association between cutaneous vasculitis and ischaemic cerebrovascular events in our Livedo patients. Conclusions We speculate that IgM anti-PS/PT Abs could be implicated in disease susceptibility for Livedo racemosa. We further suspect that cutaneous vasculitis could be closely related to pathogenic factors that trigger the development of Livedo racemosa. Early detection of cutaneous vasculitis in skin biopsies of Livedo patients should be useful for prognostic evaluation, including ischaemic cerebrovascular events.
Sadik A Khuder - One of the best experts on this subject based on the ideXlab platform.
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migraine is associated with Livedo reticularis a prospective study
Headache, 2002Co-Authors: Gretchen E Tietjen, Lorie Gottwald, Mohamed M Alqasmi, Padma Gunda, Sadik A KhuderAbstract:Objective.—To investigate the relationship of Livedo reticularis, an ischemic dermatopathy, and migraine, an ischemic stroke risk factor. Background.—Livedo reticularis refers to the reddish-blue reticular mottling of the skin resulting from narrowing of small and medium arteries at the dermis-subcutis border. A subset of patients with Livedo reticularis develop stroke in the absence of other vascular risk factors, which has been termed Sneddon syndrome. We undertook this prospective study in a non-neurology clinic to delineate further the relationship of Livedo reticularis and migraine. Methods.—Patients in a general dermatology clinic were interviewed for vascular risk factors and history of migraine in accordance with the International Headache Society (IHS) criteria. A dermatologist, not familiar with the interview, recorded the primary dermatological diagnosis and the presence or absence of Livedo reticularis on examination. Results.—Two hundred eighty-one consecutive patients (184 women and 97 men; average age, 52 years) were interviewed and examined. Seventy-five (27%) had migraine (IHS codes 1.1, 1.2) and an additional 18 (6%) had atypical migraine (IHS 1.7). Livedo reticularis was noted in 46 patients (16%), with the frequency higher in women than men (42 [23%] of 184 versus 4 [4%] of 97; P < .0001). The frequency of Livedo reticularis in patients with migraine was higher than in those without migraine (24 [26%] of 93 versus 22 [12%] of 188; P = .002), and higher in female than male migraineurs (23 [32%] of 72 versus 1 [5%] of 21; P = .012). In logistic regression analysis of the women, migraine was associated with Livedo reticularis (odds ratio [OR], 2.3; confidence interval [CI], 1.08 to 4.71), as well as with stroke (OR, 4.0; CI, 0.87 to 18.21), coronary artery disease (OR, 3.5; CI, 1.16 to 10.33), and deep venous thrombosis (OR, 3.2; CI, 0.98 to 10.32). Conclusions.—In women, migraine is associated with stroke, coronary artery disease, deep venous thrombosis, as well as Livedo reticularis, a dermatopathy which has been pathologically linked to cerebral vasculopathy. Whether migraineurs with Livedo reticularis compose a subset at higher risk of thrombosis, including stroke, deserves further investigation.
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Migraine Is Associated With Livedo reticularis: A Prospective Study
Headache, 2002Co-Authors: Gretchen E Tietjen, Lorie Gottwald, Padma Gunda, Mohamed M. Al‐qasmi, Sadik A KhuderAbstract:Objective.—To investigate the relationship of Livedo reticularis, an ischemic dermatopathy, and migraine, an ischemic stroke risk factor. Background.—Livedo reticularis refers to the reddish-blue reticular mottling of the skin resulting from narrowing of small and medium arteries at the dermis-subcutis border. A subset of patients with Livedo reticularis develop stroke in the absence of other vascular risk factors, which has been termed Sneddon syndrome. We undertook this prospective study in a non-neurology clinic to delineate further the relationship of Livedo reticularis and migraine. Methods.—Patients in a general dermatology clinic were interviewed for vascular risk factors and history of migraine in accordance with the International Headache Society (IHS) criteria. A dermatologist, not familiar with the interview, recorded the primary dermatological diagnosis and the presence or absence of Livedo reticularis on examination. Results.—Two hundred eighty-one consecutive patients (184 women and 97 men; average age, 52 years) were interviewed and examined. Seventy-five (27%) had migraine (IHS codes 1.1, 1.2) and an additional 18 (6%) had atypical migraine (IHS 1.7). Livedo reticularis was noted in 46 patients (16%), with the frequency higher in women than men (42 [23%] of 184 versus 4 [4%] of 97; P
Sundararaman Swaminathan - One of the best experts on this subject based on the ideXlab platform.
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Monoclonal cryoglobulinemia, Livedo reticularis, and renal failure.
Kidney international, 2012Co-Authors: Nitin Relia, Neriman Gokden, Satyarth Kulshrestha, Sundararaman SwaminathanAbstract:A 45-year-old Hispanic woman was referred for evaluation of renal failure and a 5-year history of burning pain in the lower extremity with worsening skin changes. Physical examination was remarkable for Livedo reticularis of lower extremities (Figure 1) and gangrene of the toes. Workup for autoimmune and hypercoagulable conditions was negative, except for positive serum cryoglobulin at 24 h. Peripheral blood smear showed eosinophilic-stained deposits consistent with cryoglobulin being phagocytosed by a neutrophil (Figure 2). Skin biopsy also revealed cryoglobulinemic deposits and multiple thrombi within dermal vessels. Renal pathology was consistent with thrombotic microangiopathy. The patient was started on plasma exchange treatment, with subsequent improvement observed in her skin changes, leg pain, and renal function.