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.