Refractory Livedoid Vasculopathy: Clinical Response to TNF-α Blocker in a Young Male Patient.

Abstract

Livedoid vasculopathy is a rare condition characterized by thrombosis of dermal vessels, predominantly affecting the ankles. The patient presented with a painful ulcer, which is usually chronic in nature with relapsing-remitting episodes. It may resemble other vasculitides disorders, such as microscopic polyangiitis and polyarteritis nodosa. Hence, diagnosis is mainly based on clinical and histopathological findings. Livedoid vasculopathy required antiplatelet and anticoagulant therapy, in contrast to vasculitides disorders. We describe a young man who presented with a recent onset of painful ulcers on both ankle regions, consistent with livedoid vasculopathy and supported by histopathological findings. Clinical remission was observed after treatment with subcutaneous adalimumab, after failing to respond to a combination of anticoagulant, corticosteroid, vasodilator, and antiplatelet agents.