title: Atypical presentation of livedo racemosa in a factor V Leiden heterozygous positive patient with Pseudomonas aeruginosa urosepsis.
abstract: Impairment of the protein C pathway, detectable by reduced plasma levels of activated protein C (APC), are risk factors for venous thrombosis. Activated protein C maintains clotting homeostasis by regulation of pro-coagulant factors Va and VIIIa. Both infection and the factor V Leiden mutation reduce the formation of APC from protein C in the blood. With low levels of APC, excess factors Va and VIIIa exist, increasing the risk of thrombus formation. Livedo racemosa is characterised by a striking, violaceous branch-like pattering of the skin. It is similar to livedo reticularis, but with a different morphology and histopathology. In this case report we present the first case of livedo racemosa, in an 89-year-old factor V Leiden-positive patient with a Pseudomonas aeruginosa urinary tract infection. The cutaneous biopsies demonstrated vasculopathy with intraluminal thrombi in subcutaneous vessels with no evidence of inflammatory vasculitis.
authors.affiliation: Veracity Clinical Research, Brisbane, Queensland, Australia.|Queensland Institute of Dermatology, Brisbane, Queensland, Australia.
authors.forename: Jesse
authors.initials: J
authors.lastname: Johnston
authors.affiliation: Queensland Institute of Dermatology, Brisbane, Queensland, Australia.
authors.forename: Rowland
authors.initials: R
authors.lastname: Noakes
authors.affiliation: Veracity Clinical Research, Brisbane, Queensland, Australia.
authors.forename: Kurt
authors.initials: K
authors.lastname: Davidson
mesh_terms: D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D005165:Factor V / Q000235:genetics; D005260:Female; D006579:Heterozygote; D006801:Humans; D009154:Mutation; D011552:Pseudomonas Infections / Q000150:complications*; D011550:Pseudomonas aeruginosa; D017445:Skin Diseases, Vascular / Q000150:complications* / Q000473:pathology*; D013927:Thrombosis / Q000150:complications*; D014552:Urinary Tract Infections / Q000150:complications* / Q000382:microbiology
chemical_list: D000925:Anticoagulants; C095381:factor V Leiden; D005165:Factor V
keywords: Pseudomonas aeruginosa; factor V Leiden; livedo racemosa; urosepsis