We previously reported the case of a 33-year-old woman who was diagnosed as having livedoid vasculopathy (LV) associated with plasminogen activator inhibitor-1 (PAI-1) promoter homozygosity (4G/4G).1 In patients with homozygosity for the 4G allele, high levels of PAI-1 may be associated with increased risk of venous thromboembolism, coronary disease, and poor outcome of stroke.1 This patient was successfully treated with infusions of tissue plasminogen activator (tPA) (10 mg/d for 2 weeks) after failed treatments with anti-inflammatory and antiplatelet therapies.