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Sudden onset postural livedo reticularis, cyanotic toes and multiorgan failure

Haider M Al-Attia
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DOI: https://doi.org/10.7861/clinmedicine.15-2-212d
Clin Med April 2015
Haider M Al-Attia
AUniversal Hospital, Abu Dhabi, UAE
Roles: Consultant physician in internal medicine and rheumatology
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Editor – I read with great interest the remarkable text of lesson of the month in ‘Sudden onset postural livedo reticularis, cyanotic toes and multiorgan failure’ (Clin Med June 2014 pp 314–5).

Although the case was typical of rare cholesterol embolisation syndrome (CES), the text in my opinion was lacking references to the following:

  • workup of the hypercoaguable status of the catastrophic antiphospholipid syndrome1 which can share clinical features of CES, in particular the acute development of livedo reticularis. Therefore, the relevant tests for such potential diagnosis, if any had been carried out, would have been worthwhile mentioning in the text

  • hypereosinophilia, which is known to occur in up to 80% of CES2

  • use of antiplatelet agents, and/or angiotensin-converting enzymes and angiotensin receptor blockers2 in the management of the case. Use would seem reasonable as these agents tend to prevent other adverse cardiovascular events such as myocardial infarction, a leading cause of death in patients with atherosclerosis.3,4

Despite all the above I still commend the authors who elegantly presented a rare but very serious condition.

Footnotes

  • Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk

  • © 2015 Royal College of Physicians

References

  1. 1 .↵
    1. Aguiar CL
    , Erkan D. Catastrophic antiphospholipid syndrome: how to diagnose a rare but highly fatal disease. Ther Adv Musculoskelet Dis 2013;5:305–14.
    OpenUrlAbstract/FREE Full Text
  2. 2 .↵
    1. Kronson I
    , Saric M. Cholesterol Embolization Syndrome. Circulation 2010;122:631–41.
    OpenUrlFREE Full Text
  3. 3 .↵
    1. The Heart Outcomes Prevention Evaluation Study Investigators
    . Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Eng J Med 2000;342:145–53.
    OpenUrlPubMed
  4. 4 .↵
    1. Belenfant X
    , Meyrier A, Jacquot C. Supportive treatment improves survival in multivisceral cholesterol crystal embolism. Am J Kidney Dis 1999;33:840–50.
    OpenUrlAbstract/FREE Full Text
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Sudden onset postural livedo reticularis, cyanotic toes and multiorgan failure
Haider M Al-Attia
Clinical Medicine Apr 2015, 15 (2) 212; DOI: 10.7861/clinmedicine.15-2-212d

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Sudden onset postural livedo reticularis, cyanotic toes and multiorgan failure
Haider M Al-Attia
Clinical Medicine Apr 2015, 15 (2) 212; DOI: 10.7861/clinmedicine.15-2-212d
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