SAT-592 Livedo Reticularis in Type 1 Diabetes Mellitus- A Rare Association

Abstract Disclosure: P.K. Agrawal: None. S.K. Panda: None. M. Rana: None. A. Dhikonia: None. R. Kant: None. P. Duggi: None. Introduction: Livedo reticularis (LR) is a lacy, pattern of reddish-blue to purple, cyanotic discoloration, frequently observed in the extremities and on the trunk.1,2 While commonly linked to autoimmune or thrombotic disorders, its association with type 1 diabetes mellitus (T1DM) is exceedingly rare and poorly documented. Case Presentation: We report the case of an 18-year-old female with T1DM, diagnosed at age 8, who presented with asymptomatic, persistent, reticular discoloration on her lower limbs. The lesions were non-painful and non-ulcerative. Autoimmune screening (antinuclear antibodies, antiphospholipid antibodies), inflammatory markers, and coagulation studies, was unremarkable. Doppler ultrasonography excluded deep vein thrombosis. Skin biopsy revealed non-inflammatory vascular changes with no evidence of vasculitis, consistent with idiopathic LR. Glycemic control, evaluated through HbA1c, was suboptimal (11.3%), potentially contributing to chronic endothelial dysfunction. Discussion: LR may present without any systemic association e.g. physiologic LR, primary LR, and idiopathic LR or it can be associated with many systemic diseases where it is called Secondary LR.1 Secondary LR is frequently associated with hypercoagulable states, the most common association being Antiphospholipid antibody syndrome.3 However, endocrine diseases like hypercalcemia, hypothyroidism, and diabetes can be associated with LR1,2 The occurrence of LR in T1DM may reflect chronic microvascular damage caused by persistent hyperglycemia, leading to endothelial injury and impaired perfusion. While LR is typically benign in this context, its recognition warrants a thorough evaluation to exclude systemic autoimmune or thrombotic disorders. Conclusion: This case highlights a rare dermatological manifestation of T1DM. It underscores the importance of considering LR as a potential indicator of microvascular dysfunction in diabetic patients, especially in the absence of systemic disease. Early recognition and optimization of glycemic control are essential to prevent further vascular complications. References: 1.Gibbs MB, English III JC, Zirwas MJ. Livedo reticularis: an update. Journal of the American Academy of Dermatology. 2005 Jun 1;52(6):1009-19.2. Sajjan VV, Lunge S, Swamy MB, Pandit AM. Livedo reticularis: a review of the literature. Indian dermatology online journal. 2015 Sep 1;6(5):315-21.3.Kester S, McCarty DL, McCarty GA. The antiphospholipid antibody syndrome in the emergency department setting—livedo reticularis and recurrent venous thrombosis. Annals of emergency medicine. 1992 Feb 1;21(2):207-11. Presentation: Saturday, July 12, 2025