UMEM Educational Pearls

Title: What's the Diagnosis? Image by Dr. Andrew Crouter

Posted: 8/4/2014 by Haney Mallemat, MD (Updated: 8/12/2014)
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Question

40 year-old female presents with painful lesions and ulcers on lower extremities. She has had this before, but never to this extent. She also has a history of DVT. What’s the diagnosis?

Answer

Answer: Livedoid vasculopathy or Livedoid vasculitis (LV)

Vascular disease resulting in chronic thrombosis and ulceration of bilateral lower extremities usually in young to middle-aged females. Lesions are painful purpuric macules or papules.
A vasoocclusive-type process not an inflammatory one occurring secondary to hyalinization and focal thrombosis of blood vessels. Diagnosis via biopsy.
Patients are prothrombotic with an increased risk for VTE’s (altered protein C, increased homocystine, Factor V Leiden mutation, etc.).
Treatment goals are to reduce pain, thrombosis (e.g., anticoagulants, antiplatelets, etc.), and superinfected ulcers should be treated with antibiotics covering skin flora. No increased risk of loss of life or limb with the disease.
Fantastic differential diagnoses from folks following on Twitter:
- Polyarteritis nodosum and other vasculitis diseases
- SLE and anti-phosholipid syndrome
- Levamisole toxicity
- Venous stasis ulcers
- Warfarin-induced skin necrosis

References

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