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.
Neurofibromatosis Type-1 (NF-1) can have a number of clinical exam findings. A hallmark of NF-1 are the tumors that can be anywhere (most commonly cutaneous). However, if deeper, they can lead to lymphatic obstruction as seen in our patient.
The Stanford Medicine 25 website recently passed 500,000 total visits and 375,000 unique visits since our initial launch in February, 2012. We just wanted to thank everyone for all the support!…
DRESS is an immune response seen most commonly with certain drugs including anticonvulsants (lamotrigine, carbamazepine and phenytoin) and allopurinol. The diagnosis is usually made with a rash (such as in the picture) combined with eosinophilia and end-organ dysfunction (renal failure, transaminitis or lung involvement). Many other organs can be less commonly affected.