Retiform purpura, a diagnostic-therapeutic challenge

Clinical cases and literature review

  • María Noelia Bersano Provincial Hospital of Rosario, Santa Fe, Argentina
  • Ariana Ringer Provincial Hospital of the Centenario, Santa Fe, Argentina
  • Álvaro Sanabria Provincial Hospital of Rosario, Santa Fe, Argentina
  • Marcelo Abdala Provincial Hospital of the Centenario, Santa Fe, Argentina
  • Mónica Sacnún Provincial Hospital of Rosario, Santa Fe, Argentina
Keywords: Retiform Purpura, Systemic Lupus Erytematosus, Antiphospholipidic Syndrome

Abstract

Cutaneous involvement is frequent and heterogeneous in autoimmune diseases. In some of them, such as in systemic lupus erythematosus, dermatomyositis, systemic sclerosis and antiphospholipid syndrome, some manifestations are so relevant that are included in the classification criteria. Differential diagnosis ranges in severity. Since the disease may be life-threatening, a prompt diagnosis and treatment are mandatory.  We describe a clinical case of a twenty-two-year-old woman with diagnosis of systemic lupus erythematosus and antiphospholipidic syndrome, presenting with acute, painful cutaneous lesions with necrotic aspect, fever and livedo reticularis.

Author Biographies

María Noelia Bersano, Provincial Hospital of Rosario, Santa Fe, Argentina
Rheumatology Service
Ariana Ringer, Provincial Hospital of the Centenario, Santa Fe, Argentina
Rheumatology Service National University of Rosario
Álvaro Sanabria, Provincial Hospital of Rosario, Santa Fe, Argentina
Rheumatology Service
Marcelo Abdala, Provincial Hospital of the Centenario, Santa Fe, Argentina
Rheumatology Service National University of Rosario
Mónica Sacnún, Provincial Hospital of Rosario, Santa Fe, Argentina
Rheumatology Service

References

I. Ribero S, Lipsker D, Borradori L. The Spectrum of Cutaneous Manifestations in Systemic Lupus Erythematosus and Novel Classification. Rare Diseases of the Immune System 2016;77–94.

II. Lipsker D. The need to revisit the nosology of cutaneous lupus erythematosus. Lupus. 2010; 19(9):1047–1049.

III. Miyakis S et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J Thromb Haemost. 2006;4:295-306.

IV. Wysong A, Venkatesan F. An approach to the patient with retiform purpura. 2011;24(3):151–72.

V. Carpio-Chaname, C., Vilchez-Rivera, S., Failoc-Rojas, V. E. Síndrome de Sneddon asociado a síndrome antifosfolipídico: descripciones clínicas y revisión de la literatura. Revista Colombiana de Reumatología. 2017; 24(3), 185–188.

VI. Zelger B, Chen K, Requena L, Piette W, Sunderk CH, Carlson JA, et al. Nomenclature of Cutaneous Vasculitis Dermatologic Addendum to the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. 2018;70(2):171–84.

VII. Kuhn A, Landmann A, Bonsmann G. Cutaneous Lupus Erythemato-sus. Systemic Lupus Erythematosus: Basic, Applied and Clinical Aspects. Elsevier; 2016. 333–339 p.

VIII. Chong BF, Werth VP. Skin Disease in Cutaneous Lupus Erythemato-sus. Ninth Edition. Lupus Erythematosus and Related Syndromes. Elsevier Inc.; 395–406 p.

IX. Grinnell M t al. Retiform non-blanchable purpuric plaques in a patient with systemic lupus erythematosus. 2019;1013–6.

X. Cutaneous Manifestations of Antiphospholipid Antibody Syndrome. Hematology/oncology clinics. 2008; 22:67–77.

XI. Kroshinsky D, Stone JH, Bloch DB, Sepehr A. Case 5-2009: A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs. 2009;711–20.

XII. Fanouriakis A, Kostopoulou M, Alunno A, Aringer M, Bajema I, Boletis JN, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. 2019;736–45.

XIII. Micieli R, et al. Treatment for Livedoid Vasculopathy A Systematic Review. 2018;154(2):193–202.

XIV. Asherson RA. New subsets of the antiphospholipid syndrome in 2006 : “ PRE-APS ” ( probable APS ) and microangiopathic antiphospholipid syndromes ( “ MAPS ” ). 2006;6:76–80.

XV. Cervera R. Antiphospholipid syndrome. Thrombosis Research. 2017;151(1):43–S47.

Published
2020-09-01
How to Cite
1.
Bersano MN, Ringer A, Sanabria Álvaro, Abdala M, Sacnún M. Retiform purpura, a diagnostic-therapeutic challenge: Clinical cases and literature review. Rev. Argent. Reumatol. [Internet]. 2020Sep.1 [cited 2025Jan.15];31(3):51 -54. Available from: https://ojs.reumatologia.org.ar/index.php/revistaSAR/article/view/396