Livedo reticularis

An underutilized diagnostic clue in cholesterol embolization syndrome

Kunal Chaudhary, Barry Wall, Ronnie D. Rasberry

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Cholesterol embolization syndrome (CES) is an increasingly recognized cause of acute renal insufficiency, which must be differentiated from other forms of systemic vasculitis by histologic examination of biopsies from involved organs. This report describes the optimal methods for detection and biopsy of areas of skin involved with livedo reticularis to confirm the diagnosis of CES. Methods: This report describes 8 patients with unexplained acute renal insufficiency in whom the diagnosis of CES was suspected based on their clinical history. Results: A detailed skin examination performed in both supine and upright postures demonstrated the presence of previously unrecognized livedo reticularis, which was more evident during upright posture in all subjects. In 2 subjects, questionable areas of livedo reticularis noted in supine posture became readily demonstrable during upright posture. Livedo reticularis was apparent only during upright posture in 2 subjects. Biopsies of areas of skin involved with livedo reticularis demonstrated cholesterol emboli in 6 of 8 patients and were normal in the remaining 2 patients. One patient progressed to end-stage renal disease and one was lost to follow-up. In the remaining 6 patients, renal insufficiency initially progressed but did not require dialytic therapy. Renal function returned to baseline levels and livedo reticularis resolved without recurrence in these patients. No subjects developed clinical or laboratory evidence of systemic vasculitis. Conclusions: Livedo reticularis is a common but often unrecognized finding in CES that may not be evident during routine examination performed in the supine posture. Deep cutaneous biopsy of areas of livedo reticularis can be safely used to confirm the presence of cholesterol emboli, thus avoiding the increased morbidity of biopsy of either pregangrenous skin lesions or visceral organs. Many patients with CES regain renal function during long-term follow-up.

Original languageEnglish (US)
Pages (from-to)348-351
Number of pages4
JournalAmerican Journal of the Medical Sciences
Volume321
Issue number5
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

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Livedo Reticularis
Posture
Cholesterol
Biopsy
Skin
Systemic Vasculitis
Embolism
Acute Kidney Injury
Kidney
Lost to Follow-Up
Chronic Kidney Failure
Renal Insufficiency
Morbidity
Recurrence

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Livedo reticularis : An underutilized diagnostic clue in cholesterol embolization syndrome. / Chaudhary, Kunal; Wall, Barry; Rasberry, Ronnie D.

In: American Journal of the Medical Sciences, Vol. 321, No. 5, 01.01.2001, p. 348-351.

Research output: Contribution to journalArticle

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