Bjerring, Peter

Mikkelsen, Carsten Sauer

Oppel, Lorenz

Rahim, Daniella

English

Livedo Reticularis (LR) is a well-known, relatively common physical finding consisting of macular, violaceous, connecting rings that form a netlike-pattern. Generalized livedo reticularis is a common physiological response to cold, but may be a sign of different systemic diseases. In the present case, a 79-year male presented with unilateral live do reticularis in the right leg, secondary to ruptured abdominal aorta aneurysm.Livedo Reticularis (LR) is a well-known, relatively common physical finding consisting of macular, violaceous, connecting rings that form a netlike-pattern.Generalized livedo reticularis is a common physiological response to cold, but may be a sign of different systemic diseases. In the present case, a 79-year male presented with unilateral live do reticularis in the right leg, secondary to ruptured abdominal aorta aneurysm

    Aalborg UniversitetUnilateral livedo reticularis in ruptured abdominal aorta aneurysmRahim, Daniella; Mikkelsen, Carsten Sauer; Bjerring, Peter; Oppel, LorenzPublished in:Journal of clinical images and medical case reportsDOI (link to publication from Publisher):10.52768/2766-7820/1472Creative Commons LicenseUnspecifiedPublication date:2021Document VersionPublisher's PDF, also known as Version of recordLink to publication from Aalborg UniversityCitation for published version (APA):Rahim, D., Mikkelsen, C. S., Bjerring, P., & Oppel, L. (2021). Unilateral livedo reticularis in ruptured abdominalaorta aneurysm. Journal of clinical images and medical case reports, 2(6), [1472]. https://doi.org/10.52768/2766-7820/1472General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            - Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            - You may not further distribute the material or use it for any profit-making activity or commercial gain            - You may freely distribute the URL identifying the publication in the public portal -Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Downloaded from vbn.aau.dk on: November 19, 2022Open Access, Volume 2 Unilateral livedo reticularis in rupturedabdominal aorta aneurysmCase Reportwww.jcimcr.orgJournal ofClinical Images and Medical Case ReportsReceived: Oct 20, 2021Accepted: Dec 06, 2021Published: Dec 13, 2021Archived: www.jcimcr.orgCopyright: © Rahim D (2021).DOI: www.doi.org/10.52768/2766-7820/1472*Corresponding Author: Daniella RahimCand Med Resident, Department of Neurology, Aal-borg University hospital, Denmark. Email: daniellarahim14@gmail.comISSN 2766-7820Daniella Rahim1*; Carsten Sauer Mikkelsen2; Peter Bjerring3; Lorenz Oppel41Cand Med Resident, Department of Neurology, Aalborg University hospital, Denmark. 2Specialist in Dermato-Venereologi, Private Practise in Dermato-venereologi, Brønderslev, Senior Research Fellow, Department of Dermato-venereology, Aalborg University hospital, Denmark.3Specialist in Dermato-Venereologi, Clinical Professor, Dr.Med., Department of Dermato-Venereology, Aalborg University Hospital, Denmark.4Specialist in Neurology, Senior Hospital Physician, Clinical Proffesor, Dr.Med., Department of Neurology, Aalborg University hospi-tal, Denmark.AbstractLivedo Reticularis (LR) is a well-known, relatively common physical finding consisting of macular, violaceous, connecting rings that form a netlike-pattern. Generalized livedo reticularis is a common physiological response to cold, but may be a sign of different systemic diseases. In the pres-ent case, a 79-year male presented with unilateral live do reticularis in the right leg, secondary to ruptured abdominal aorta aneurysm.IntroductionLivedo Reticularis (LR) is a net-like discoloration of the skin, due to disturbance in blood flow pattern in the superficial ves-sels of the skin. The low blood flow will result in higher rela-tive amounts of deoxygenated hemoglobin, leading to a more violaceous/blueish color of the superficial capillaries [1,2]. LR is classified as either primary idiopathic or secondary to other un-derlying pathological conditions. Any physiological process, that impairs the blood flow can cause LR, such as cold, hyper-viscos-ity or systemic inflammation. Unilateral LR may also be present after local heat injury, also referred to as Erythemaabigne [2].Case reportA 79-year male with a medical history of hypertension and prostate cancer was treated with watch-and-wait strategy. He was admitted dyspnea and fever and treated with penicillin for pneumonia. He responded with improved respiration and decreasing CRP. However, at the fifth day of admission he de-veloped paresis of the left leg. The left leg exhibited pale skin and paresis and LR was found on the trunk and right leg (Figure 1). Furthermore, palpatory pain was registered in the lower left abdominal fossa. A normal ABCDE-status was found and blood test showed an insignificant low hemoglobin (7.2 mmol/l). www.jcimcr.org                Page 2Citation: Rahim D, Mikkelsen C, Bjerring P, Oppel L. Unilateral livedo reticularis in ruptured abdominal aorta aneurysm. J Clin Images Med Case Rep. 2021; 2(6): 1472.Figure 1: Pale left leg and LR manifestation.Acute CT-scan of the abdomen revealed an eight cm left-sid-ed, ruptured infra-renal abdominal aorta aneurysm with retro-peritoneal hematoma (Figure 2). The patient underwent acute abdominal surgery with insertion of a stent. Post-surgically, the patient had regained normal power in left leg and the skin co-lour normalized.Figure 2: Abdominal CT-scan with contrast, demonstrating rup-turet infrarenal aortic aneurysm, with retroperitoneal hematoma on the left side.DiscussionLR is caused by a disturbance in the blood flow in the su-perficial vessels in the skin. The reduced and re-directed blood flow increases the relative amount of deoxygenized hemoglo-bin to oxygenized hemoglobin resulting in a prominent blue/violet color of the visible, superficial vessels. Universal LR is a normal physiological response to cold but may also be a sign of systemic disease such as sepsis [1] and even COVID-19 [3]. Focal LR is rare, but have been presented in case reports with bilateral LR in the legs, caused by cholesterol embolisms originating from abdominal aorta aneurysms, which further caused secondary kidney failure [4].It is speculated that the present LR was caused by activation of the sympathetic nervous system, as a response to blood loss due to the erupted aorta aneurysm. The blood flow was further obstructed to the left leg due to the retroperitoneal hematoma thereby causing paresis and pale colour of the left leg. References1.  Sajjan V, Swamy M, Lunge S, Pandit A. Livedo reticularis: A re-view of the literature. Indian Dermatol Online J. 2015; 6: 315. 2.  Gawkrodger DJ (David J., Ardern-Jones MR. Dermatology : an il-lustrated colour text [Internet]. 7th ed. 2020; 164.3.  Manalo IF, Smith MK, Cheeley J, Jacobs R. A dermatologic mani-festation of COVID-19: Transient livedo reticularis. J Am Acad Dermatol. 2020; 83: 700. 4.  Singh NP, Gupta AK, Kaur G. Atheroembolic renal disease. Vol. 30, Indian Journal of Nephrology. Wolters Kluwer Medknow Publications. 2020; p. 1–2.

Unilateral livedo reticularis in ruptured abdominal aorta aneurysm

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Unilateral livedo reticularis in ruptured abdominal aorta aneurysm

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