Deepak Sudheendra: When a Vascular Looking Skin Pattern Isn’t Vascular
Deepak Sudheendra, CEO and Medical Director at 360 Vascular Institute, Founder and Medical Director at AngioCare LLC, shared a post on LinkedIn:
“The Skin Pattern Looked Vascular. The Diagnosis Wasn’t.
Recently a patient from FL was referred to me for evaluation of peripheral artery disease because of a striking mottled pattern on his legs consistent with Livedo reticularis (LR).
His history included a recent Traumatic Brain Injury (TBI). After discharge, he began noticing the skin changes.
LR is often associated with cold temperatures and vasospasm, so it was interesting that this developed despite him living in a warm climate.
I reviewed the timeline and his medications and one medicine stood out…Amantadine.
This medication is often used in the treatment of Parkinson’s Disease, but he did not have a history of PD.
I asked him why he was on it, and he replied that he did not know, but that it was started after he was discharged from the hospital for TBI.
I asked him if he noticed the LR after starting amantadine, and he recalled that it appeared about 1 month after starting the medication.
I did a literature search and…
Amantadine-induced livedo reticularis.
A dramatic skin finding that looks vascular but is actually medication-related.
While amantadine is often used in the treatment of Parkinsons, it is also used in the treatment of TBI.
As his amantadine dose has been lowered, the LR has begun to fade.
Cases like this are a reminder that experience matters.
Recognizing patterns and carefully reviewing the history often leads to the right diagnosis, sometimes before any test is ordered.
At the same time, medicine is a field where we are constantly learning which is one of the things I love most about it.
Even with years of experience, cases like this remind me that there is always something new to learn.”
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