Successful treatment of refractory livedoid vasculopathy in a patient with systemic lupus erythematosus

Abstract

Livedoid vasculopathy (LV) also known as livedoid vasculitis is a rare and chronic thrombotic vasculopathy that typically affects the lower extremities. Diagnosis of LV are not well defined and the treatment are widely varied. We report a case of 30 years old female patient diagnosed with Livedoid vasculopathy and systemic lupus erythematous as underlying diseases. Patient presented with chief complain painful ulcer on her bilateral lower extremities. Hypercoagulable state was normal. Skin biopsy found that dermal vessels filled with erythrocytes extravasation and inflammation cell PMN. ANA profile was positive for RNP/Sm suggest that a systemic lupus erythematosus. Patient underwent successful treatment planning for methylprednisolone 16 mg twice daily, hydroxychloroquine 200 mg once daily and methotrexate 10 mg once a week. The ulcer completely resolved after 2 months of the treatment and had no recurrent ulcer. LV is a rare, chronic, and occlusive disease of the veins supplying the upper parts of the skin. Histopathological finding is thickening or hyaline changes in the walls of superficial dermal vessels and luminal fibrin deposition. Red cell extravasation and perivascular lymphocytic infiltrates are expected findings. SLE was underlying condition that cause endothelial injury and leads to thrombosis of the dermal vessels. no treatment guidelines are available for LV. Methylprednisolone, hydroxychloroquine and methotrexate have successful therapeutic response to a patient with ulcerative LV and SLE as underlying diseases.