[Livedoid erythema of the lower back revealing thrombosed abdominal aortic aneurysm]

We report the case of a patient presenting a very painful livedo of the lower back as well as paraparesis revealing a complicated abdominal aortic aneurysm.

A 61-year-old man was referred to our emergency unit for sudden lower back pain and weakness of the lower limbs. He had a large and very painful livedo racemosa on the lower back as well as partial neurological deficit of the lower limbs. Abdominal CAT revealed a bulky thrombosed infrarenal aortic aneurysm. Despite surgery, ischaemia worsened, leading to cutaneous then muscular and visceral necrosis, followed by death.

Livedo racemosa of the lower limbs may be the consequence of thrombosis or embolism resulting from an abdominal aortic aneurysm. Livedo racemosa on other skin areas is uncommon but may be due to the same physiopathology. Neurological deficit is occasionally associated with a complicated abdominal aortic aneurysm or with surgical treatment thereof. However, to our knowledge, livedo on the back associated with neurological deficit has not yet been reported. Such an association should prompt practitioners to screen for a thrombosed aortic aneurysm. Furthermore, this condition is also likely to carry a poor prognosis because of the proximal secondary location of the thrombotic phenomenon, involving the lumbar arteries, which supply the medullar, cutaneous and muscular arteries.