Clinical Insights and Diagnostic Dilemmas: Two Cases of Livedoid Vasculitis

Authors

  • Nanda Earlia Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; Department of Dermatology and Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
  • Sulamsih Sri Budini Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; Department of Dermatology and Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
  • Wahyu Lestari Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; Department of Dermatology and Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
  • Risna Handriani Department of Dermatology and Venereology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia; Department of Dermatology and Venereology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
  • Fitri Dewi Ismida Department of Anatomy Pathology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, Indonesia
  • Aldilla Pradistha Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
  • Teuku Muhammad Muizzy Dinillah Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
  • Dara Avinda Vemulen Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia
  • Athira Athira Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh 23111, Indonesia

DOI:

https://doi.org/10.60084/ijcr.v2i1.183

Abstract

Livedoid Vasculitis (LV) is a thrombo-occlusive vasculopathy involving dermal vessels, especially in the lower extremities. Clinical symptoms of LV are chronic, recurrent, scarring, and painful purpuric ulcers. Diagnosing and providing therapy for LV is a challenge because there are no standard guidelines. We present clinical insights and diagnostic approaches on two cases of LV to improve early diagnosis and prevent misdiagnosis, which were confirmed based on history, dermatological examination, and skin biopsy. In the first case, it was a woman, 23 years old, who came with complaints of a blackish-red rash appearing on both legs. There were scars on several parts of the patient's legs, which felt painful, and the legs looked swollen. On histopathological examination, fibrin deposition in the vessel walls, endothelial proliferation, and intraluminal hyaline thrombin were found. In the second case, it was a man, 19 years old, who came with complaints of pain when walking accompanied by wounds on both lower legs. On histopathological examination, fibrin deposition in the vessel walls, endothelial proliferation, and intraluminal hyaline thrombin were found. The conclusion from the histopathology results was LV. After receiving therapy, both cases showed improvement: swelling in the legs was reduced, red and black rashes began to disappear, ulcers improved, pain decreased, and scars became blurred. These two cases provide examples of success in diagnosing LV. Being able to diagnose LV early and correctly is very important so that adequate therapy can be given and good outcomes can be achieved.

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References

  1. Burg, M. R., Mitschang, C., Goerge, T., and Schneider, S. W. (2022). Livedoid Vasculopathy – A Diagnostic and Therapeutic Challenge, Frontiers in Medicine, Vol. 9. doi:10.3389/fmed.2022.1012178.
  2. Seguí, M., and Llamas-Velasco, M. (2022). A Comprehensive Review on Pathogenesis, Associations, Clinical Findings, and Treatment of Livedoid Vasculopathy, Frontiers in Medicine, Vol. 9. doi:10.3389/fmed.2022.993515.
  3. Weishaupt, C., Strölin, A., Kahle, B., Kreuter, A., Schneider, S. W., Gerss, J., Eveslage, M., Drabik, A., and Goerge, T. (2019). Characteristics, Risk Factors and Treatment Reality in Livedoid Vasculopathy – a Multicentre Analysis, Journal of the European Academy of Dermatology and Venereology, Vol. 33, No. 9, 1784–1791. doi:10.1111/jdv.15639.
  4. Majmundar, V. D., and Baxi, K. (2023). Livedoid Vasculopathy, StatPearls [Internet], StatPearls Publishing.
  5. Bilgic, A., Ozcobanoglu, S., Bozca, B. C., and Alpsoy, E. (2021). Livedoid Vasculopathy: A Multidisciplinary Clinical Approach to Diagnosis and Management, International Journal of Women’s Dermatology, Vol. 7, No. 5, 588–599. doi:10.1016/j.ijwd.2021.08.013.
  6. Jia, E., Yan, G., Xiao, M., Geng, H., Wei, J., and Zhang, J. (2020). Refractory Ulcerations Associated with Livedoid Vasculopathy Successfully Treated with Tofacitinib, Dermatologic Therapy, Vol. 33, No. 6. doi:10.1111/dth.14470.
  7. Eswaran, H., Googe, P., Vedak, P., Marston, W. A., and Moll, S. (2022). Livedoid Vasculopathy: A Review with Focus on Terminology and Pathogenesis, Vascular Medicine, Vol. 27, No. 6, 593–603. doi:10.1177/1358863X221130380.

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Published

2024-05-10

How to Cite

Earlia, N., Budini, S. S., Lestari, W., Handriani, R., Ismida, F. D., Pradistha, A., Dinillah, T. M. M., Vemulen, D. A., & Athira, A. (2024). Clinical Insights and Diagnostic Dilemmas: Two Cases of Livedoid Vasculitis. Indonesian Journal of Case Reports, 2(1), 19–23. https://doi.org/10.60084/ijcr.v2i1.183

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