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Case Reports
. 2024 Jan-Dec:12:23247096241266090.
doi: 10.1177/23247096241266090.

Negative Results, Positive Outcome: A Case of Primary Livedoid Vasculopathy With an Elusive Laboratory Workup

Ahmed Dheyaa Al-Obaidi  1 , Shireen Kh Sabeeh  2 , Maab Jasim Mohammed  2 , Assalah Othman  3 , Yousif Ahmed Algburi  1 , Hashim Talib Hashim  4 , Ahmed Qasim Mohammed Alhatemi  5 , Zahraa Al Hilali  6 , Bilal Riyadh Taresh Al-Attabi  5 , Abdullah Al-Awad  1
Affiliations
Case Reports

Negative Results, Positive Outcome: A Case of Primary Livedoid Vasculopathy With an Elusive Laboratory Workup

Ahmed Dheyaa Al-Obaidi et al. J Investig Med High Impact Case Rep. 2024 Jan-Dec.

Abstract

Livedoid vasculopathy (LV) is a chronic, recurrent thrombotic vasculopathy characterized by painful ulcerations on the lower extremities, which heal slowly and leave atrophic white scars known as "atrophie blanche." This report presents the case of a 31-year-old woman with a 4-year history of recurrent painful ulcerations on her legs and feet. A skin biopsy revealed findings consistent with LV, and an exhaustive laboratory workup ruled out secondary causes such as thrombophilia, malignancies, autoimmune diseases, and peripheral arterial disease. The patient showed remarkable improvement with a treatment regimen of pentoxifylline, nifedipine, and warfarin, resulting in complete ulcer resolution and sustained remission over 5 months. Our case highlights the importance of a comprehensive diagnostic approach and a multidisciplinary treatment strategy in managing primary LV to achieve remission and prevent recurrence of skin ulcerations.

Keywords: atrophie blanche; livedoid vasculopathy; nifedipine; pentoxifylline; ulceration; warfarin.

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Conflict of interest statement

Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Livedo reticularis all over her lower limbs.
Figure 2.
Figure 2.
Unhealed ulcers over the lateral malleolus.
Figure 3.
Figure 3.
Skin biopsy histopathology analysis showing fibrin thrombi within vessel lumens, extravasation of red blood cells, and perivascular lymphocyte infiltration.
Figure 4.
Figure 4.
Complete healing of the ulcer following treatment.
See this image and copyright information in PMC

References

    1. Kang S, Amagai M, Bruckner AL, et al.. Fitzpatrick’s Dermatology. 9th ed. McGraw-Hill Education; 2019:2532-2533.
    1. Weishaupt C, Strölin A, Kahle B, et al.. Characteristics, risk factors and treatment reality in livedoid vasculopathy: a multicentre analysis. J Eur Acad Dermatol Venereol. 2019;33(9):1784-1791. - PubMed
    1. Micieli R, Alavi A. Treatment for livedoid vasculopathy: a systematic review. JAMA Dermatol. 2018;154:193-202. - PubMed
    1. Alavi A, Hafner J, Dutz JP, et al.. Livedoid vasculopathy: an in-depth analysis using a modified Delphi approach. J Am Acad Dermatol. 2013;69(6):1033-1042. - PubMed
    1. Poletti ED, Sandoval NRM, González JLM, et al.. Vasculopatía livedoide: significado actual. Comunicación de dos casos. Dermatol Rev Mex. 2008;52:175-181.

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