N. Iagăru 1, Tania Cristodulo 2, Monica Dărmănescu 3, Irina Mărgăritescu 4, A. D. Chiriţă 5
1 MD, PhD, Associate Professor of Pediatrics, University of Medicine and Pharmacy “Carol Davila” – The Institute of Mother and Child Care “Alfred Rusescu”
2 MD, Dermatology, Colentina Clinical Hospital
3 MD, Dermatology, IMCC “Alfred Rusescu” Hospital
4 MD, dipRCPath, Domina Sana Medical Center
5 MD, dipICDP-UEMS, Domina Sana Medical Center
Abstract
Objectives. To distinguish those cases of local cutaneous vasculitis in children very difficult to diagnose and classify in the absence of other clinical characteristic findings. Materials and methods. Two patients presenting with unusual cutaneous chronic vasculitis in children with early onset in the first decade of life are reported. Results. Clinical features (livedo reticularis), histopathologic changes (presence in the reticular dermis of fibrin in the wall of venules and thrombi within their lumen) and the evolution (healing with atrophie blanche) were necessary to identify the diagnosis in each case, in order to exclude other types of vasculitis. Complex laboratory investigations were done in order to do this. Finally, the diagnosis in both cases was livedoid vasculitis. Conclusions. Proper diagnosis of livedo reticularis with recurrent ulcers of the lower extremities that heal to leave hyperpigmentation and atrophie blanche is very important, because ulcers may result from a variety of small vessel vasculitis which do not require the same treatment. Patients with livedoid vasculitis may be associated with various systemic diseases including hypercoagulable states, so a complete evaluation is required.