Dependent Erythema of the Legs Associated With Mild Autonomic Nervous System Dysfunction.

INTRODUCTION: Dependent erythema or rubor is an erythematous discoloration of the limbs, most commonly associated with peripheral artery disease. We present a case of florid dependent erythema, associated with additional autonomic symptoms. METHODS: Examination and full workup of a 16-year-old healthy girl with an 8-year history of dependent erythema, chronic diarrhea, and mild hyperhidrosis. A literature search was performed to review any similar cases and generate a differential diagnosis. RESULTS: Examination of our patient showed symmetrical, asymptomatic fiery to dusky erythematous patches of the lower legs and feet, with intermittent areas of pallor. These florid changes occurred with erect posture. Resolution to near normal occurred within minutes when the patient was in the supine position. Full physical examination revealed mild erythema and hyperhidrosis of the hands. CONCLUSIONS: To our knowledge, there have been no reports of painless dependent rubor associated with sympathetic dysfunction. Literature search reports a few cases of gravitational erythema and angiodyskinesia. This case presentation is most likely part of the spectrum of dependent erythema and may shed light on the underlying aetiology.