Patient has this new skin finding, what should you worry about?
November 14, 2013
This is an actual cause of a patient who presented to Stanford Hospital and was diagnosed with pneumonia. He had this skin finding present throughout both of his legs. What should you be worried about?
This patient has livedo reticularis. This can be a sign of severe bacteremia and possible sepsis. This patient was later diagnosed with bacterial pneumonia, bacterial meningitis and later grew streptococcal pneumonia in his blood. He was treated in the ICU and recovered fully a week later.
Livedeo reticularis can have a number of causes. Some of these include vasculitis (e.g. polyarteritis nodosa & lupus erythomatosis), anti-phospholipid antibody syndrome (APAS), cryoglobulinemia and cholesterol emboli syndrome. Some patients will develop this finding in cold weather and is a normal finding. Similar to Raynaud’s phenomenon, this benign variant is more common in young women.
A 46-year-old Vietnamese female with history of Churg-Strauss syndrome was seen for a flare-up and had the above skin changes. Based on the characteristics pattern can you diagnose the cause of this skin rash?…
37 yr old male with a history of these lesions on his the back of his hands for the past two years. Notes no other medical issues. No weakness, fatigue, fevers or rashes anywhere else on his body. He works as a chiropractor and is concerned about his patients seeing his hands. Use of various over the counter treatments such as topical steroids and moisturizers did not improve the lesions.