[Atypical and revelatory livedo reticularis!?]

Atherosclerosis is a frequent and life-threatening complication in elderly patients with multimorbidity as well as with one or multiple cardiovascular risk factors. It can affect all the arterial trunks of the lower limbs and can cause obliterative arterial disease of the lower limbs. We here report the case of an elderly patient with ecchymotic livedo reticularis of the right thigh revealing ipsilateral obliterative arterial disease of the lower limb with septic loosening of total hip prosthesis. The study involved a 70-year old man with favorable atheromatous condition complicated 6 months before by ischemic heart disease revascularized with double prostheses (stent) and with right total hip prosthesis implanted 10 years before. He presented with large mesh and incomplete livedo reticularis associated with ecchymoses on the right thigh (A). Clinical examination showed reduced distal pulses in the right lower limb. Laboratory tests showed discrete inflammatory syndrome and normal haemostatic and immunological tests . Standard radiographic evaluation of the right hip showed a loosening of the distal end of the prosthesis (C). Echo-doppler of the lower limbs and angio-scanner showed occlusion of the right external iliac axis, right double primitive iliac stenosis and a lesion due to septic dislocation of the right femoral prosthesis with abscess collection measuring 48 mm/30 mm ( B). The patient was referred to the Division of Vascular Surgery for revascularization. Vascular imaging by echo-doppler and/or angio-scanner should be performed, in particular in elderly patients with livedo reticularis or venous collateral circulation and with cardiovascular risk factors.