Patients with thrombotic antiphospholipid syndrome (APS) or subjects with persistent presence of antiphospholipid antibodies (aPLA), defined "carriers", may develop thrombocytopenia. However, the prevalence and clinical characteristics associated with thrombocytopenia remain poorly understood. We aimed to describe the prevalence and the clinical characteristics associated with thrombocytopenia in APS patients and aPLA carriers included in the Survey on AnTicoAgulated Patients-RegisTry on antiphospholipid antibodies (START-APS), a multicentre prospective registry. Thrombocytopenia was defined as a platelet count < 150 × 10[9]/L, while moderate-to-severe form was defined as < 100 × 10[9]/L. Logistic regression analysis was performed, and results were expressed as Odds Ratio (OR) and 95% confidence interval (95%CI). A total of 464 patients were included (148 aPLA carriers, 316 APS), mean age was 57.3 ± 15.6 years, and 66.5% were women. 63 (13.6%) patients presented with thrombocytopenia; 15.2% in APS patients and 10.1% in aPLA carriers (p = 0.138). Overall, triple positive pattern (OR 1.90, p = 0.002), livedo reticularis (OR 3.57, p = 0.029), heart failure (OR 4.52, p = 0.039), and female sex (OR 0.59, p = 0.011) were associated with thrombocytopenia. Triple positivity (OR 5.44, p < 0.001) and history of myocardial infarction (OR 6.52, p = 0.009) were associated with moderate-to-severe thrombocytopenia. Thrombocytopenia may occur early also in aPLA carriers, raising to 15% in APS patients, especially in those presenting with triple positivity and cardiovascular involvement. This association was confirmed also with moderate-to-severe thrombocytopenia.

ObjectiveTo describe the prevalence, clinical manifestations, histopathological features, and antibody profile associated to skin involvement in patients with catastrophic antiphospholipid syndrome (CAPS).MethodsWe performed a cross-sectional study of the patients included in the "CAPS Registry," a registry developed by the European Forum on Antiphospholipid Antibodies (aPL)1,2 This database contains data from patients with CAPS collected from April 1992 to December 2024. Demographic clinical manifestations, laboratory features (including aPL antibodies), pathological findings in involved skin, and outcome were retrieved.ResultsCutaneous involvement was described in 377 episodes (47%) from 361 patients. A female sex prevalence of 49.4% was observed. The average age was 39.4 (SD ± 17.9) years. The more frequent skin manifestations observed were livedo reticularis (17.6%), skin necrosis (13%), ischemic ulcers (10.4%), skin ischemic (9.7%), skin purpura (7.1%), gangrene (5%), splinter haemorrhages (2.6%), and Raynaud's phenomenon (1.5%). The most frequently affected organs in CAPS episodes with skin involvement were kidneys (72%), lungs (61%), central nervous system (54.5%), and heart (54.4%). Thrombocytopenia and hemolysis features were more common in patients with skin involvement (p < 0.05 for all). Thrombotic microangiopathy was the predominant pathological finding, present in 82 (68.3%) episodes. No difference regarding mortality were found in episodes with or without skin involvement (29.3% vs 32.1%, p = 0.42).ConclusionThe presence of skin involvement in patients with CAPS is frequent. The most frequent manifestations were livedo reticularis and skin necrosis. Skin involvement does not seem to be associated to mortality.

Background: Vascular adverse events (VAEs) related to facial filler injections are rare but potentially severe complications. Doppler ultrasound has emerged as an adjunct imaging tool for evaluating vascular compromise; however, Doppler findings in facial VAEs remain insufficiently characterized. Objectives: To characterize Doppler ultrasound findings associated with filler-related facial VAEs and to assess whether Doppler patterns differ according to prior hyaluronidase administration. Methods: This international multicenter retrospective observational study included 100 patients with clinically diagnosed facial VAEs following filler injections between May 2022 and April 2025. Doppler ultrasound findings were analyzed, including absent flow in perforators and major arteries, compensatory flow, abnormal waveforms, increased peak systolic velocity (PSV), and absence of Doppler abnormalities. Patients were categorized according to hyaluronidase administration prior to ultrasound evaluation. Descriptive statistics and comparative analyses were performed. Results: One hundred patients (median age, 38 years; IQR: 30-50; 88 women) were evaluated. The most frequent Doppler ultrasound findings were absent flow in perforators (42%) and major arteries (35%), followed by compensatory flow (26%), string sign (18%), flow diversion (16%), and increased peak systolic velocity (16%). No Doppler abnormalities were observed in 12% of cases, while tardus-parvus (9%) and staccato waveform (8%) were less frequent. Doppler ultrasound findings did not differ significantly between patients who received hyaluronidase before imaging and those who did not (all p > 0.05). The dose of hyaluronidase varied substantially. Livedo reticularis, blanching, and pain were the most common clinical findings. Central facial arterial territories, particularly the perioral, nasolabial fold, nasal, and glabellar regions, were most commonly involved. Conclusions: Filler-related facial VAEs show recognizable Doppler ultrasound patterns, and the identification of these patterns may improve localization of vascular occlusion and support ultrasound-guided hyaluronidase administration, potentially enabling more targeted delivery with lower doses.

West Nile virus neuroinvasive disease (WNND) most commonly presents as meningitis, encephalitis, or acute flaccid paralysis, with variable neuroimaging findings. While MRI abnormalities classically involve deep gray matter and brainstem structures, hemorrhagic manifestations are rarely reported. We report a 77-year-old woman who presented with rapidly progressive altered mental status following a brief febrile prodrome. Cerebrospinal fluid studies demonstrated a lymphocytic pleocytosis consistent with aseptic meningitis. Brain MRI revealed an acute lacunar infarct and diffuse cerebral microhemorrhages initially concerning for cerebral amyloid angiopathy. During hospitalization, she developed livedo reticularis-like peripheral skin changes prompting evaluation for autoimmune or vasculitic etiologies. Extensive infectious and autoimmune testing was ultimately notable for positive serum and CSF West Nile virus serologies, confirming neuroinvasive WNV infection. Despite transient neurologic improvement, her clinical course deteriorated, and she died following transition to comfort-focused care. This case highlights diffuse cerebral microhemorrhages as a potential finding in WNND, although their attribution remains uncertain. These findings may reflect underlying neurovascular inflammatory injury related to WNV or may represent coincident pathology and can mimic other small-vessel or autoimmune pathologies, complicating early diagnostic evaluation. Recognition of this expanded radiographic and clinical spectrum may aid timely diagnosis of WNND in patients with atypical presentations.

Transarterial chemoembolization (TACE) is a commonly used locoregional therapy for hepatocellular carcinoma (HCC), with rare complications related to nontarget embolization. We describe a case of hepatic falciform artery (HFA) embolization following drug-eluting bead TACE (DEB-TACE), resulting in transient ischemic injury of the anterior abdominal wall. A 71-year-old man with Child-Pugh A cirrhosis and multifocal HCC developed a livedo-reticularis-like rash over the epigastrium 2 days after DEB-TACE. Retrospective review of angiographic and cross-sectional imaging identified a hepatic falciform artery arising from the hepatic arterial system, consistent with nontarget embolization. The patient was managed conservatively, with complete resolution over several months. The HFA is an anatomically variable vessel that may be difficult to identify on angiography. Awareness of this entity is important to recognize characteristic imaging findings, guide patient counselling, and minimize procedural complications during TACE.

Vascular occlusion is an uncommon but serious complication of hyaluronic acid filler injections. If not recognized and managed early, it can lead to ischemia and even skin necrosis. Timely diagnosis and intervention are therefore crucial to minimize tissue damage and avoid long-term consequences. With the rising popularity of chin augmentation procedures, awareness of these rare complications is increasingly important for aesthetic practitioners. This report describes the case of a 54-year-old woman who presented with increasing pain, skin discoloration, and livedo reticularis approximately 24 hours after she had received hyaluronic acid filler injections in her chin. Clinical examination revealed delayed capillary refill time and mottled skin changes across the chin and neck. The high-dose pulsed hyaluronidase protocol was initiated 25 hours after injection. A total of 2850 IU of hyaluronidase was administered in a series of doses during a 15-hour period. Alongside enzyme therapy, the patient received oral aspirin, warm compresses, and gentle massage. Her symptoms improved quickly, and by day 21, she had fully recovered with no scarring or volume loss. This case highlights that even minimal filler volumes can trigger vascular occlusion. Preparedness to identify the vascular complications and apply the high-dose pulsed hyaluronidase protocol is essential to ensure full recovery and safeguard patient outcomes.

Lane-Hamilton syndrome is a rare association between idiopathic pulmonary hemosiderosis (IPH) and celiac disease that can present with isolated hemoptysis. We describe a case of a previously healthy 15-year-old female who presented with 1 month of intermittent hemoptysis, chest pain, and severe iron deficiency anemia. Physical examination was remarkable for mild conjunctival pallor and livedo reticularis. Extensive laboratory studies were obtained to rule out infectious, rheumatological, and oncological explanations of anemia. A chest radiograph showed an increased density in the left mid-lung and bilateral opacities, and computed tomography showed scattered multifocal ground glass opacities. Bronchoalveolar lavage revealed hemosiderin-laden macrophages consistent with the diagnosis of IPH. Additional workup for IPH revealed elevated celiac titers. Upper endoscopy confirmed the diagnosis of celiac disease, which led to a final diagnosis of Lane-Hamilton syndrome, a rare co-occurrence of IPH and celiac disease. The treatment plan included a course of systemic steroids and a gluten-free diet. Given this known association, workup for IPH should include testing for celiac disease since a gluten-free diet may prevent future occurrences of alveolar hemorrhage.

Abdominal aortic aneurysm is defined as the abnormal dilation of the abdominal aorta to a diameter of three centimeters or greater. The risk of rupture increases significantly when the aneurysm is greater than 6 centimeters in diameter. Ruptured abdominal aortic aneurysms carry a mortality rate of up to 83%, with up to a third of these deaths occurring before the patient reaches the hospital. Symptoms of dissection or rupture of the abdominal aorta include a tearing sensation in the back, lower extremity weakness, sudden and severe abdominal pain, and hypotension. Symptoms are often vague, and some patients have few symptoms until they develop hypotension and shock. In this case presentation, a 65-year-old male presented to the emergency department with sudden onset of leg weakness, and was noted to have a well demarcated livedo reticularis rash. A computed tomography scan showed a large abdominal aortic aneurysm with evidence of active hemorrhage within the aneurysm. He underwent surgical repair and was discharged in good condition.