A 30-year-old woman presented with progressive, symmetrical, jagged and reticulate erythema and hyperpigmentation of the lower legs (Figure) consistent with livedo racemosa. Her past medical history was remarkable for four embryonic miscarriages. A thrombophilia screen showed an elevated homocysteine level of 63 μmol/L (reference range, 5–15 μmol/L). She was commenced on aspirin 100 mg daily, with improvement observed at 2 weeks, after which she was lost to follow-up. Livedo racemosa may indicate a vascular insult; most commonly a medium-vessel vasculitis or hypercoagulable state. Identification and treatment of the driving pathology is needed to mitigate end-organ damage.
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