"This is a rare case of two diseases with different mechanisms but both related to the vascular system", said Associate Professor Doctor Hoang Thi Lam, head of Clinical Immunology at Tam Anh District 7 General Clinic, on 19/5.

Anh Thuc's condition was severe upon his arrival at Tam Anh District 7 General Clinic, having persisted for years. His legs were nearly deformed by numerous ulcers and necrosis, and pain prevented him from walking. His face was swollen from prolonged corticosteroid use, and he had previously developed adrenal insufficiency due to uncontrolled medication. Symptoms, including dense dark purple patches on both legs and ulcers from ankles to calves, first appeared 4 years prior, causing sharp pain when walking. Despite seeking various treatments, both traditional and modern, his condition did not improve.

Livedo reticularis is a chronic skin disease resulting from microvascular occlusion by thrombi, characterized by purple patches and painful ulcers on the lower legs and feet. The other condition, necrotizing vasculitis, is a severe systemic disease that causes inflammation and destruction of vessel walls, potentially affecting multiple organs such as the skin, kidneys, and lungs. The coexistence of these two conditions complicated vascular damage, increasing the risk of tissue ischemia and further complications.

Doctor Lam advises Anh Thuc on treatment methods. Photo: Tam Anh District 7 General Clinic

According to Doctor Lam, necrotizing vasculitis can lead to severe complications if not controlled promptly, potentially causing deep necrosis that requires surgical intervention. While livedo reticularis is not life-threatening, it causes chronic, recurrent pain, significantly affecting quality of life. After a comprehensive assessment, doctors adjusted Anh Thuc's treatment regimen to a personalized approach, focusing on the pathogenesis rather than just symptom control.

Treatment for livedo reticularis aimed to improve circulation and limit thrombosis using anticoagulants and aspirin. Necrotizing vasculitis was managed with immunosuppressants, with corticosteroids used during the acute phase to control inflammation. Doctor Lam advised that corticosteroids offer quick anti-inflammatory effects but should not be used long-term due to risks like edema, metabolic disorders, osteoporosis, and adrenal insufficiency. His medication dose was gradually reduced, with instructions to avoid sudden cessation. Immunomodulators were added, alongside ulcer care and close monitoring of inflammation, coagulation, liver, and kidney function.

After two weeks, Anh Thuc's flare-ups significantly decreased, his pain improved, and skin lesions were controlled. The patient stabilized, his facial edema resolved, and he could walk, perform daily activities, and return to work.

For vascular diseases like necrotizing vasculitis or livedo reticularis, accurate diagnosis and pathogenesis-based treatment are crucial. Initial symptoms can easily be mistaken for benign skin lesions, making diagnosis challenging. If only symptoms are treated, the disease often recurs and progresses over time. Individuals experiencing abnormal purple skin, chronic ulcers, persistent, or recurrent pain should seek early medical examination for a full assessment.

Minh Huong

*Patient's name has been changed.