A 25-year-old female smoker with hypertension presented with a several-month history of progressive painful cyanosis, livedo reticularis, and necrotic lesions on the distal region of her extremities. She had nephrocalcinosis and end-stage renal disease of unclear etiology. She had started receiving hemodialysis shortly before the cutaneous signs developed. Abdominal pain and cardiac dysrhythmias were additional recent medical problems. Examination revealed necrozing livedo reticularis on the distal area of the upper and lower extremities, with necrotic eschars over the digits and dorsa of the feet (Figure 1 and Figure 2). Radial, brachial, and femoral pulses were diminished but palpable. Popliteal, posterior tibial, and dorsalis pedis pulses were detectable only on Doppler examination.
O'Reilly MA, Meadows KP, Egan CA. Necrotizing Livedo Reticularis. Arch Dermatol. 2001;137(7):957-962. doi: