[Livedo with cerebrovascular thrombosis--correlation between clinical features, anti-cardiolopin antibodies, and...

Twenty one patients with livedo racemosa (LRa) and periarteritis nodosa cutanea were screened for the presence of anti-cardiolipin antibody (aCL) by ELISA. 11 out of 21 revealed positive aCL whose clinical features could be divided into 3 groups: 4 patients with livedo with ulceration, 2 with pyoderma gangrenosum-like lesions, and 5 with extensive LRa. #1. The summer ulceration of leg of 4 patients were surrounded by several tiny petechiae where hyaline microthrombi of blood capillaries in the upper dermis were demonstrated. All had multiple cerebral microinfarctions on magnetic resonance imaging (MRI). #2. Pyoderma gangrenosum-like lesions of 2 patients consisted of painful punched-out ulcers on livedoid lesions where intravascular endothelial hyperplasia in a small artery was demonstrated. Both had multiple cerebral microinfarctions. #3. Another clinical manifestation of the patients with positive aCL was extensive form of LRa of 5 patients. All had positive ANA, however none of them exhibited cerebral microinfarctions on MRI. #4. The remaining 10 patients with negative aCL showed no relationship with such clinical and laboratory manifestations. These results indicate that there is a significant correlations between summer ulceration with petechiae, capillary microthrombi of the skin, positive aCL and cerebral microinfarctions on MRI.