RESUMO
Livedoid vasculopathy is a rare, chronic-recurrent occlusive disorder in the microcirculation of dermal vessels. The clinical appearance is characterized by Livedo racemosa, painful ulceration, located in the distal parts of the lower extremities, followed by healing as porcelain-white, atrophic scars, the so-called Atrophie blanche. Different conditions that can promote a hypercoagulable state, such as inherited and acquired thrombophilias, autoimmune connective-tissue diseases and neoplasms, can be associated with livedoid vasculopathy. Therefore, livedoid vasculopathy is currently considered to be a coagulation disorder, clearly distinguished from inflammatory vasculitis. Although there are hints to hypercoaguability and secondary inflammation, pathophysiology is not completely understood. Diagnosis is made by synopsis of history, clinical and histopathological findings. Early and adequate therapy is essential to maintain life quality and avoid irreversible complications. Better understanding of molecular mechanisms is required to establish appropriate therapy regimens. This article presents the current state of knowledge about livedoid vasculopathy and proposes an algorithmic approach for diagnosis and therapy.
RESUMO
Long-term methotrexate (MTX) treatment is known to cause MTX-associated lymphoproliferative disorder (MTX-LPD). A 58-year-old woman with psoriasis vulgaris and pityriasis rubra pilaris was treated with a combination of MTX and ustekinumab for 4 months when she developed generalized lymphadenopathy. The initial histopathological analysis indicated Hodgkin's lymphoma; however, assessing the patient's clinical history revealed the diagnosis of MTX-LPD. To our knowledge, this is the first case of a MTX-LPD after only 4 months of treatment.
