Livedoid血管病变(LV)可能是具有挑战性的诊断,具有有趣的病理生理学。LV是一种不常见的诊断,很容易被误认为是更常见的皮肤疾病。尤其是在医学教育中使用的病理学图像中可能代表性不足的有色人种中。LV从初次出现到诊断平均5年,可能是由于提供者没有将其用于下肢溃疡的差异。延长诊断时间可能导致改变生活的并发症。我们介绍了一名前专业短跑运动员,他因LV并发症继发的神经病而衰弱。他被多次看到,并进行了广泛的检查,探索了包括自身免疫性病因在内的广泛差异,高凝紊乱,神经病,和其他血管疾病在达到诊断之前。该病例强调了早期诊断和多学科团队治疗的重要性,以帮助预防这些症状的进展。我们打破了广泛的工作,涉及多学科团队,包括皮肤科,血液学,神经学,风湿病,血管手术.此病例还将突出显示患有深色皮肤肤色的患者的LV示例,这在当前的文献中可能是具有挑战性的。我们还显示了许多与LV相关的经典病理发现的图像,以及这些图像如何帮助诊断以及这些发现的详细描述。强调了经典的身体检查结果,包括萎缩性布兰奇和下肢溃疡。我们还回顾了LV的历史,诊断,和治疗,以帮助读者更好地了解疾病。
Livedoid vasculopathy (LV) can be a challenging diagnosis with an interesting pathophysiology. LV is an uncommon diagnosis that can be easily mistaken for more common skin conditions, especially in a person of color who may be underrepresented in pathology images used in medical education. LV has an average of five years from initial presentation to diagnosis, possibly due to providers not having it on their differential for lower extremity ulcerations. Prolonged time to diagnosis can potentially lead to life-changing complications. We present a case of a former professional sprinter who became debilitated by neuropathy secondary to complications from LV. He was seen multiple times and had an extensive work-up exploring a broad differential including autoimmune etiologies, hypercoagulable disorders, neuropathies, and other vascular disorders before reaching the diagnosis. This case emphasizes the importance of early diagnosis and treatment with a multidisciplinary team to help prevent the progression of these symptoms. We break down an extensive work-up that involves a multidisciplinary team including dermatology, hematology, neurology, rheumatology, and vascular surgery. This case will also highlight examples of LV in a patient with a dark skin complexion, which can be challenging to find in current literature. We additionally show images that demonstrate many of the classic pathologic findings associated with LV and how those can help lead to the diagnosis along with detailed descriptions of those findings. Classic physical exam findings including atrophic blanche and lower extremity ulcerations are highlighted. We also review LV\'s history, diagnosis, and treatment to help readers achieve a better understanding of the disease.