Livedoid Vasculopathy in a Female Patient With a History of COVID-19 Infection During Pregnancy: A Case Report

Livedoid vasculopathy is a rare, chronic thrombo-occlusive disease characterized by recurrent livedoid skin changes, atrophic white plaques, and ulceration. It most commonly affects the dermal vessels of the distal lower extremities, ankles, and feet, bilaterally. While it is commonly associated with hypercoagulable states, systemic autoimmune diseases, and malignancies, we report a case of a previously healthy 31-year-old female with a history of moderate COVID-19 infection during pregnancy, two years before the onset of livedoid skin changes. The patient presented to a hematologist with a two-month history of erythematous to violaceous macules and patches on the dorsum of the feet, ankles, and lower extremities, along with mild ankle swelling. Multiple punch biopsies of the affected skin demonstrated thrombi, fibrinoid vascular changes, fibrosis, and hyalinization of the vessel walls - findings consistent with vasculopathy. Initial treatment included subcutaneous low-molecule weight heparin (dalteparin). This case highlights the importance of early recognition, the performance of a skin biopsy with subsequent histopathologic diagnosis, and appropriate management of this rare, but potentially debilitating condition.