Sudden and transient livedo reticularis as a manifestation of mononucleosis‐like disease by cytomegalovirus

Abstract

We report a case of livedo reticularis (LR) caused by cytomegalovirus (CMV) infection in a male infant with LR accompanied by pyrexia, increased white blood cell count and atypical lymphocytes in the peripheral blood. Leukaemia was excluded by bone marrow examination, and anti-CMV IgM and IgG antibodies were elevated.LR is a relatively common skin manifestation caused by microcirculatory dysfunction. Various diseases may cause this condition, including circulatory organ disease, collagen disease, vasculitis, leukaemia and infectious diseases. Although CMV infection is reported to induce peripheral vasculitis and distal ischaemic necrosis, 1,2 other vascular disorders have not been reported. We report a case of CMV-related LR with spontaneous regression.A 2-month-old boy presented with a 1-month history of sudden onset LR on the extremities (Fig. 1a).No ischaemic changes such as necrosis and ulcer were noted. The child's medical and delivery histories were unremarkable. Imaging tests of the whole body showed no abnormalities.Laboratory investigations revealed increased white blood cell count (33.79 9 10 9 /L; normal range 4-11 9 10 9 /L) with atypical lymphocytes (5.0%) and elevated levels of hepatic enzymes

Transient breast livedo reticularis‐like exanthem in an adolescent with COVID‐19

“…Livedo reticularis‐like eruptions have also been described in different viral infections 2 . Likewise, COVID‐19‐associated cutaneous manifestations include a livedo reticularis/racemosa‐like pattern 1 .…”

“…Livedo reticularis‐like eruptions have also been described in different viral infections. 2 Likewise, COVID‐19‐associated cutaneous manifestations include a livedo reticularis/racemosa‐like pattern. 1 The transient livedo reticularis‐like exanthem in COVID‐19 is mildly symptomatic and typically presents in a symmetric distribution mostly involving the limbs, 3 , 4 though unilateral cases have been reported.…”

Cytomegalovirus infection associated with livedo reticularis, erythromelalgia, and superficial venous thrombosis

“…CMV has been associated with rare reports of vascular disorders, including LR. 2 , 3 , 4 There have also been reports of CMV-associated cutaneous necrotizing vasculitis and acute hemorrhagic edema. 2 , 3 In our case, we noted development of multiple vascular sequelae associated with CMV infection including LR, erythromelalgia, and SVT.…”

“…It occurs most commonly over the lower extremities. 1 , 2 , 3 LR is often a physiologic response secondary to cold temperatures causing vasospasm of the superficial cutaneous vasculature. However, LR can also be associated with medications, autoimmune conditions (lupus erythematosus or polyarteritis nodosum), or injury to the vascular lumen from circulating proteins such as cryoglobulins.…”

“… 2 , 3 Antibodies to antigens from infections are hypothesized to induce intraluminal damage and thereby lead to LR. 2 Early recognition of infectious etiologies of LR can lead to timely diagnosis and avoidance of unnecessary workup. In this case report, we describe cytomegalovirus (CMV) infection associated with LR as well as erythromelalgia and superficial venous thrombosis (SVT).…”