title: A combination of livedo racemosa, occlusion of cerebral blood vessels, and nephropathy: kidney involvement in Sneddon's syndrome.
abstract: A 59-year-old woman with retinal vein thrombosis and livedo racemosa had hematuria (4+) and proteinuria (1.7 g/day). Skin biopsy showed swollen blood vessel walls with infiltration of mononuclear cells, which were compatible with livedo racemosa (vasculitis). Magnetic resonance imaging (MRI) of the brain demonstrated multiple lacunar infarctions in the basal ganglia and white matter. Renal biopsy showed that small round cells had infiltrated into the interstitium, and a reticular structure was observed in the glomerular hilus. An amorphous substance composed of a single cell was present in the glomerular capillary lumen. Immunofluorescent study demonstrated the deposition of only IgA, in a segmental pattern differing from the diffuse global mesangial pattern seen in IgA nephropathy. After combined therapy including 40 mg/day prednisolone, 50 mg/day cyclophosphamide, antiplatelet drug, and anticoagulant was started, proteinuria and hematuria improved to 0.5 g/day and 2+, respectively, at the time of discharge. Sneddon's syndrome is a rare entity characterized by livedo racemosa and cerebrovascular lesions. In our patient with livedo racemosa, occlusion of cerebral blood vessels, and nephropathy with segmental immunoglobulin A (IgA) deposition, no antiphospholipid antibodies were detected on routine examination. Dermatologists, neurologists, psychiatrists, and nephrologists should be aware of the existence of Sneddon's syndrome with nephropathy (LI-O-N).
authors.affiliation: Third Department of Internal Medicine, Akita University School of Medicine, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Ohtani
authors.forename: H
authors.initials: H
authors.lastname: Imai
authors.forename: T
authors.initials: T
authors.lastname: Yasuda
authors.forename: H
authors.initials: H
authors.lastname: Wakui
authors.forename: A
authors.initials: A
authors.lastname: Komatsuda
authors.forename: K
authors.initials: K
authors.lastname: Hamai
authors.forename: A B
authors.initials: AB
authors.lastname: Miura
mesh_terms: D017152:Antibodies, Antiphospholipid / Q000097:blood; D002544:Cerebral Infarction / Q000276:immunology / Q000473:pathology*; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000276:immunology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012170:Retinal Vein Occlusion / Q000150:complications; D017445:Skin Diseases, Vascular / Q000473:pathology*; D013577:Syndrome; D014657:Vasculitis / Q000276:immunology / Q000473:pathology*
chemical_list: D017152:Antibodies, Antiphospholipid