J Clin Neurol.  2011 Dec;7(4):233-236. 10.3988/jcn.2011.7.4.233.

Ischemic Neuropathy Associated with Livedoid Vasculitis

• Kim JE
• Park SY
• Sinn DI
• Kim SM
• Hong YH
• Park KS
• Sung JJ
• Lee KW

• KMID: 2179011
• DOI: http://doi.org/10.3988/jcn.2011.7.4.233

Abstract

BACKGROUND
Livedoid vasculitis is a chronic dermatological problem with an unclear etiology. Clinical findings are petechiae with painful ulcers in both lower extremities, which heal to become hyperpigmented and porcelain-white satellite lesions. There are only a few reported cases of livedoid vasculitis presenting in combination with peripheral neuropathy.
CASE REPORT
We report the first case of a Korean patient presenting with mononeuritis multiplex combined with livedoid vasculitis, which was confirmed by electrophysiological and pathological studies.
CONCLUSIONS
Our report supports the possible vaso-occlusive etiology of livedoid vasculitis in multifocal ischemic neuropathy.

Keyword

livedoid vasculitis; livedoid vasculopathy; mononeuritis multiplex; multifocal ischemic neuropathy

MeSH Terms

Humans
Lower Extremity
Mononeuropathies
Purpura
Ulcer
Vasculitis

Figure

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  Fig. 1 Multiple painful ulcerations with healed white scarring in the bilateral lateral malleolar area. A: left lateral malleolar area. B: right lateral malleolar area.

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  Fig. 2 Histopathology findings of a sural nerve biopsy. A: Extensive infarct of the peripheral nerve and Schwann cells (hematoxylin-eosin stain, original magnification ×40). B: Endoneurial capillary ectasia and congestion with hemorrhage (hematoxylin-eosin stain, original magnification ×200). C: Intravascular thrombosis with mild lymphocytic infiltration present in the epineurium. There was no definite neutrophilia or leukocytoclasia, suggesting vasculitis (i: hematoxylin-eosin stain, ii: leukocyte common antigen stain, original magnification ×200). D: Electron micrograph showing marked degeneration of axons and their myelin sheath, with the Schwann cell cytoplasm containing many autophagic vacuoles and myelin figures.

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