PMC9021422_01
(A) Bier Anemic spots, cyanosis, and urticaria-like eruption (BASCULE) of lower limbs while orthostatism in a 14-year-old patient. Skin eruption is characterized by erythrocyanic background (1) with anemic macules (Bier spots) (2), and urticaria-like eruption (3). (B) Blood pressure and heart rate evolution during tilt-test. The blue curve represents the systolic pressure, the red curve represents the diastolic pressure, and the green curve represents the average heart rate as a function of time before and after tilt-test. After verticalisation, heart rate increased to 110-120 bpm while blood pressure remained around 120/70 mmHg, which is characteristic of a postural orthostatic tachycardia syndrome (POTS) associated with cerebral hypoperfusion-symptoms include lightheadedness, syncope, palpitations, and fatigue. This condition is associated with an increase in heart rate >30 bpm (or >40 bpm in children/adolescents younger than 19 years) within 10 min of standing (or during a head-up tilt-test to at least 60 ) in the absence of orthostatic hypotension. (C) Clinical course during the tilt-test. Clinical features before the tilt-test (A), during the tilt-test (B1,B2), and after the tilt-test (C).
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However, 10 min of orthostatism triggered a skin eruption characterized by anemic macules on an erythrocyanic background with hatching in the lower limbs (Figure 2A). After verticalization, heart rate increased to 110-120 bpm, while blood pressure remained around 120/70 mmHg (Figure 2B). All symptoms disappeared within 5 min after returning to the lying position (Figure 2C).