# Livedoid Vasculopathy with Severe Debilitating Neuropathy in a Prior Professional Athlete

## TL;DR

A former professional athlete developed severe neuropathy due to a rare skin condition called livedoid vasculopathy, which was misdiagnosed for years.

## Contribution

This case highlights the diagnostic challenges of livedoid vasculopathy in patients with dark skin and emphasizes the need for multidisciplinary care.

## Key findings

- LV was diagnosed after an extensive work-up involving multiple specialists.
- Classic physical exam findings like atrophic blanche and ulcerations were key to diagnosis.
- The case emphasizes the importance of early diagnosis to prevent severe complications.

## Abstract

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.