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Rheumatic Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
A ‘butterfly’ rash, acute cutaneous lupus erythema over the cheeks and the bridge of the nose, exacerbated by ultraviolet light, is characteristic of lupus. Livedo reticularis may be present. Raynaud's phenomenon will occur in approximately 50% of patients at presentation. This describes the colour changes of the hands that occur as a result of digital vasospasm, usually associated with cold weather. Typically, the fingers turn white (ischaemia), blue–purple (deoxygenation of the blood) and then red (reperfusion hyperaemia).
Dermatological manifestations of cardiovascular emergencies
Published in Biju Vasudevan, Rajesh Verma, Dermatological Emergencies, 2019
Aseem Sharma, O. Biby Chacko, Madhulika Mhatre
Livedo reticularis: An erythematous to livid-blue, mottled, net, or lace-like discoloration is the classic finding. Other findings include ulceration, cyanosis, purpura, necrosis, gangrene, and painful nodules. Most cases involve the lower extremities and are often symmetrical and bilateral. Treatment of the primary condition (after ruling out vasculitis) causes improvement [14].
Clinical presentations for chronic venous diseases
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
Secondary livedo reticularis is a pathologic variant associated with autoimmune diseases, or is veno-oclusive from hyperviscosity, cryoglobulins, drugs such as amantadine or infection such as hepatitis C or mycoplasma. It usually spreads beyond the legs to the buttocks and torso. It is necessary to differentiate the usually painless, symmetrical, unbroken vessel network of primary livedo reticularis from the frequently painful, irregular, asymmetrical and broken pattern observed in the secondary condition often associated with livedo racemosa.
Evaluating ADS5102 (amantadine) for the treatment of Parkinson’s disease patients with dyskinesia
Published in Expert Opinion on Pharmacotherapy, 2019
Thomas Müller, Wilfried Kuhn, Jan-Dominique Möhr
A low incidence of side effects is one of the major benefits of amantadine. Livedo reticularis and pedal edema are common. Livedo reticularis is usually limited to the skin of the legs. Distinct less common, but more troublesome, are the mental side effects such as confusion, visual hallucinations and insomnia. They promptly disappear with drug discontinuation. Generally, the cognitive side effects were reported in individuals with an underlying pre-existing cognitive dysfunction. There is even one case report on a dropped head syndrome occurring with amantadine exposure, which again disappeared after stopping the amantadine treatment [34]. The predominant renal amantadine excretion asks for cautious use of amantadine in patients with impaired kidney function. Dry mouth and blurred visions are probably related to the mild anticholinergic properties of amantadine.
Extended-Release Amantadine for Levodopa-Induced Dyskinesia
Published in Expert Review of Neurotherapeutics, 2019
Khashayar Dashtipour, Ali R. Tafreshi, Rajesh Pahwa, Kelly E. Lyons
For the primary efficacy analyses, all doses showed a reduction of dyskinesia compared to placebo at week eight, but only the 340 mg and 420 mg doses met statistical significance. Eighty-seven percent of the patients reported an adverse event (AE), with 82% of the placebo group, and 95% of the 340 mg group reporting AEs. AEs occurring in more than 10% in any group were as follows: constipation, dizziness, hallucination, dry mouth, fall, confusion, headache, nausea, and asthenia. But the most common AEs in the treated groups were constipation, hallucination, dizziness and dry mouth. Livedo reticularis was reported in one patient who received amantadine ER 340 mg and none of the patients in this study developed impulse control disorders. For reference, the final list of adverse events from the GOCOVRI package insert is made available (Table 2) [42].
Successful treatment with cyclosporine and anti-tumour necrosis factor agent for deficiency of adenosine deaminase-2
Published in Scandinavian Journal of Rheumatology, 2021
D Keino, K Kondoh, Y Kim, A Sudo, R Ohyama, M Morimoto, H Nihira, K Izawa, S Iwaki-Egawa, T Mori, A Kinoshita
She was diagnosed with idiopathic PRCA. CyA 4.5 mg/kg/day was started at approximately 1.5 months after admission because she was dependent on red blood cell transfusion. We performed a biopsy because the livedo reticularis persisted and oedema of the lower limbs appeared. Biopsy of the skin of the lower limb revealed necrotizing vasculitis, and a diagnosis of cutaneous polyarteritis nodosa (cPAN) was made (Figure 1). She responded to treatment with CyA and became transfusion independent. The dose of CyA was gradually reduced, and approximately 10 months after diagnosis, she self-interrupted treatment with CyA. Six months after self-interruption, she became transfusion dependent again. Resumption of CyA improved her anaemia.