Acta Dermato-Venereologica, issue 9 97-9CompleteContent | Page 28

QUIZ SECTION Livedo Reticularis on the Lower Limbs in a Patient with Lupus Erythematosus: A Quiz Elodie MIQUELESTORENA-STANDLEY 1,2 , Alia SALEH 3 , Anne LATASTE 4 , Christophe MONEGIER DU SORBIER 1 and Laurent MACHET 2,3 * 1 Department of Pathology, CHRU, 2 PRES Centre, Val de Loire University, University Francois Rabelais de Tours, FR-37044 Tours, 3 Department of Dermatology, and 4 Department of Nephrology, CHRU Tours, France. *E-mail: [email protected] A 47-year-old woman presented with reticulate skin lesions on her knees (Fig. 1) at the end of December 2016. She had a long history of systemic lupus erythematosus (SLE) that had started 26 years ago with malar rash and arthritis. Routine blood test results were within the normal range. The patient was positive for antinuclear and double-strand DNA antibodies, antiphospholipid antibodies and lupus anticoagulant. She was given topical corticosteroids and hydroxychloroquine. Three years later, the patient presented with renal involvement and was given systemic corticoste- roids and an immunosuppressive drug. Thrombophlebitis and pulmonary embolism occurred in 1995, and was treated with warfarin (Coumadin ® ) with international normalized ratio (INR) between 2.5 and 3.5. Laboratory blood test re- sults in May 2016 showed a moderate increase in antinuclear antibodies titre (1:200 dilution) and anti-DNA antibodies (43 IU, normal < 14 IU).The dermatologist promptly refer- red the patient to a tertiary care hospital for complementary investigations. A skin biopsy was taken (Fig. 2) and blood tests were performed. What is your diagnosis? See next page for answer. Fig. 1. (a) Livedo reticularis on both lower limbs. (b) Erythematous and reticulate lesions with incomplete circles on the right limb. The biopsy site is circled. (c) On the less-involved lower limb, the reticulate lesions were more yellow-brownish, with complete circles. Fig. 2. Histology revealed dilated capillary vessels in the mid- dermis, with normal capillary walls, and no capillary thrombosis (periodic-acid Schiff stain; original magnification ×200). 1148 doi: 10.2340/00015555-2708 Acta Derm Venereol 2017; 97: 1148–1149 This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2017 Acta Dermato-Venereologica.