The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Case Report

Livedo Reticularis: A Rare Manifestation of Graves Hyperthyroidism Associated with Anticardiolipin Antibodies

Authors: Yair Liel, MD

Abstract

Livedo reticularis is a common presentation of the anti-cardiolipin syndrome. Although the presence of anticardiolipin (aCL) antibodies was previously reported in association with both Graves disease and Hashimoto thyroiditis, I am aware of no previous report of livedo reticularis in patients with Graves disease. A 29-year-old woman presented with very active Graves thyrotoxicosis. Physical examination revealed, in addition to signs of very active hyperthyroidism, marked livedo reticularis on both her legs. Laboratory tests confirmed the clinical impression regarding her thyroid activity and revealed prolonged prothrombin time (and partial thromboplastin time) and elevated levels of both immunoglobulin G and immunoglobulin M aCL antibodies. After methimazole-induced remission, livedo reticularis completely disappeared and the levels of aCL antibodies decreased to within the low range of normal. The literature on aCL antibodies and autoimmune thyroid diseases is reviewed and the interaction between the occurrence of aCL antibodies, disease activity, and drug therapy in Graves disease is discussed.

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References

1. Levine JS, Branch DW, Rauch J. The antiphospholipid syndrome. N Engl J Med 2002;346:752–763.
 
2. Picascia DD, Pellegrini JR. Livedo reticularis. Cutis 1987;39:429–432.
 
3. Marongiu F, Conti M, Murtas ML, et al. Anticardiolipin antibodies in Graves disease: Relationship with thrombin activity in vivo. Thromb Res 1991;64:745–749.
 
4. Mathieu E, Fain O, Sitbon M, et al. Systemic adverse effect of antithyroid drugs. Clin Rheumatol1999;18:66–68.
 
5. Parker JL, Lawson DH. Death from thyrotoxicosis. Lancet 1973;2:894–895.
 
6. Hofbauer LC, Spitzweg C, Heufelder AE. Graves disease associated with the primary antiphospholipid syndrome. J Rheumatol 1996;23:1435–1437.
 
7. Mayaudon H, Crozes P, Riveline JP, et al. Antiphospholipid antibodies in Basedow disease [in French]. Presse Med 1994;23:1496 (letter).
 
8. Diez JJ, Doforno RA, Iglesias P, et al. Anticardiolipin antibodies in autoimmune thyroid disease. J Clin Lab Immunol 1993;40:125–134.
 
9. Paggi A, Caccavo D, Ferri GM, et al. Anti-cardiolipin antibodies in autoimmune thyroid diseases. Clin Endocrinol (Oxf) 1994;40:329–333.
 
10. Shoenfeld Y, Krause I. Immunosuppression and immunomodulation of experimental models of systemic lupus erythematosus and antiphospholipid syndrome. Transplant Proc 1996;28:3096–3098.
 
11. Petri M, Nelson L, Weimer F, et al. The automated modified Russell viper venom time test for the lupus anticoagulant. J Rheumatol 1991;18:1823–1825.
 
12. Tani Y, Morita M, Noguchi S. Prevalence of prolonged APTT and lupus anticoagulant in autoimmune thyroid disease [in Japanese]. Rinsho Byori 1997;45:899–902.
 
13. Evangelopoulou ME, Alevizaki M, Toumanidis S, et al. Mitral valve prolapse in autoimmune thyroid disease: An index of systemic autoimmunity?Thyroid 1999;9:973–977.