Clinicopathological Challenge: A Painful Violaceous Reticulated Patch

Hyaluronic acid (HA) injection is commonly used as a treatment for osteoarthritis for lubrication, and its therapeutic efficacy is gaining increasing importance in an aging society. Vascular complications are infrequent; existing literature typically describes knee involvement manifesting as retiform purpura patterns, managed with heparin or hyaluronidase. Herein, we present a case of livedo racemosa after intra-articular (IA) HA injection which resolved with acetylsalicylic acid and topical fusidic acid with a conservative approach. To our knowledge, while antithrombotic and rheological strategies for IA HA complications predominantly involve low-molecular-weight heparin, pentoxifylline, or subcutaneous hyaluronidase, reports of successful resolution through the maintenance of acetylsalicylic acid monotherapy are limited.