Rheumatology 2018;0:1 Clinical Vignette doi:10.1093/rheumatology/key061 Blue toe syndrome in cutaneous polyarteritis FIG.1 Livedo and blue toe in the 2 patients nodosa Blue toe syndrome is a blue discoloration of the toes already reported once in cutaneous polyarteritis nodosa (cPAN) . Macular lymphocytic arteritis (MLA) is a cutaneous medium-vessel vasculitis characterized by pigmented macules and lymphocytic infiltration of the vessels, mostly considered as a benign form of cPAN . We report two patients having blue toe syndrome, one with cPAN and one with MLA. The first patient had a livedo racemosa (Fig. 1A) and later a blue toe appear- ance of the second right toe (Fig. 1B) that became necrotic. cPAN diagnosis was confirmed by histology of the livedo that showed inflammatory medium sized arteriolitis of the dermo-hypodermic junction. The second patient had a livedo racemosa (Fig. 1C) and a sudden purplish appearance of the toes (Fig. 1D). Treatment using high dose steroids and prostacyclin allowed regression of the blue toe syndrome in both Infiltrated livedo (A) then blue toe (B) in patient 1. cases. Non-infiltrated livedo (C) then blue toe and peripheral Atypical cPAN skin symptoms include white atrophy, ischaemia (D) in patient 2. acrocyanosis, RP, peripheral gangrene and ulcers and ‘in- flammatory plaques with peripheral nodules. The mech- anisms involved in our cases may combine initial vessel 3 4 Conakry, Guinea, Pathology Department and Internal wall inflammation and late thrombotic events. The occur- Medecine Department Saint Louis Hospital, Paris, France rence of blue toes in the course of cPAN or MLA is a rare but probably severe complication requiring urgent recog- *Florence Cordoliani and Jean-David Bouaziz equally con- nition and management. tributed to this study Correspondence to: Jean-David Bouaziz, Department of Funding: No specific funding was received from any Dermatology, Saint Louis Hospital, 1 Avenue Claude bodies in the public, commercial or not-for-profit sectors Vellefaux, 75475 Paris, France. to carry out the work described in this manuscript. E-mail: email@example.com Disclosure statement: The authors have declared no References conflicts of interest. 1 Tschetter AJ, Liu V, Wanat KA. Cutaneous polyarteritis 1,2 1 Thierno Mamadou Tounkara , Marie Jachiet , nodosa presenting as a solitary blue toe. J Am Acad 1 3 Laure Frumholtz , Maxime Battistella , Dermatol 2014;71:e957. 2 4 1 Mohamed Cisse , Alfred Mahr , Martine Bagot , 2 Buffiere-Morgado A, Battistella M, Vignon-Pennamen MD 1, 1, Florence Cordoliani * and Jean-David Bouaziz * et al. Relationship between cutaneous polyarteritis nodosa Dermatology Department, Saint Louis Hospital and Paris VII (cPAN) and macular lymphocytic arteritis (MLA): blinded Sorbonne Paris Cite´ University, Paris, France, Dermatology histologic assessment of 35 cPAN cases. J Am Acad Department, Gamal Abdel Nasser University of Conakry, Dermatol 2015;73:101320. The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: firstname.lastname@example.org Downloaded from https://academic.oup.com/rheumatology/advance-article-abstract/doi/10.1093/rheumatology/key061/4925530 by Ed 'DeepDyve' Gillespie user on 08 June 2018
Rheumatology – Oxford University Press
Published: Mar 9, 2018
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