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Livedo racemosa: Ungewöhnliche Spätmanifestation einer Borreliose?
June 7, 2025
What Is Livedo Racemosa?
Livedo racemosa (LR) is a vascular skin condition characterized by irregular, branching, reddish-blue patterns caused by slowed blood flow in deeper skin vessels . Unlike livedo reticularis—a reversible, temperature-dependent marbling—LR is persistent and linked to systemic diseases like antiphospholipid syndrome (APS), lupus, or infections .
Key Features:
Appearance: “Broken” net-like patterns with open, asymmetrical rings.
Pathophysiology: Focal blood flow obstruction due to vessel inflammation or clotting .
Associations: APS (50% of cases), vasculitis, or infections like tuberculosis or syphilis .
Lyme Disease’s Cutaneous Timeline
Lyme disease, caused by Borrelia bacteria, progresses through stages:
Early Localized: Erythema migrans (EM) rash (70–80% of cases).
Early Disseminated: Multiple EM lesions, neurological/cardiac symptoms.
Late-Stage: ACA (thinning skin on extremities) and, rarely, LR .
The 2000 case study revealed LR co-occurring with ACA, both showing histological similarities and Borrelia antibodies, suggesting a shared vascular pathology .
Diagnostic Challenges: Is It Lyme or Something Else?
LR’s diverse causes make diagnosis a puzzle:
- Critical Steps:
- APS (check anticardiolipin antibodies) .
- Drug-induced lupus (e.g., dilantin) .
- Cholesterol emboli or infections like syphilis .
Case Clue: In Lyme-associated LR, ACA-like tissue changes and positive serology support the link .
Recent Discoveries: Lyme’s Expanding Clinical Spectrum
- APS Overlap: LR in APS patients correlates with stroke risk, hinting at shared thrombotic mechanisms .
- Drug-Induced LR: Medications like amantadine or dilantin can mimic LR, complicating diagnosis .
Treatment: Targeting the Root Cause
- Lyme-Associated LR: Prolonged antibiotics (doxycycline, ceftriaxone) .
- APS-Related LR: Anticoagulants (warfarin) and antiplatelet therapy .
- Symptomatic Care: Vasodilators (e.g., calcium channel blockers), avoiding cold exposure .
Note: LR may persist despite treatment, requiring long-term monitoring .
Tables at a Glance
Table 1: Livedo Racemosa vs. Livedo Reticularis
Table 2: Top Causes of Livedo Racemosa
Antiphospholipid syndrome (50%)
Cutaneous polyarteritis nodosa
Lyme disease (rare)
Drug-induced lupus
Table 3: Case Studies Linking LR to Lyme Disease
| Case | Age/Sex | Key Findings | Outcome | |
|---|---|---|---|---|
| Baumann et al. (2000) | 59/F | ACA + LR, positive Borrelia serology | Improved with antibiotics |
Conclusion: A Call for Clinical Vigilance
Livedo racemosa’s link to Lyme disease remains rare but underscores the importance of considering infections in differential diagnoses. For patients with unexplained LR, Lyme serology and histological analysis could prevent missed cases and late complications. As research evolves, this striking skin pattern may become a beacon guiding clinicians to hidden systemic threats.