Livedo Racemosa Associated with Autoimmune Disease and Neuropathic Symptoms: Management with Lumbar Sympathetic Block

Objectives Livedo racemosa is a cutaneous vascular pattern often associated with systemic disease, including antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE). Patients may experience associated neuropathic and autonomic symptoms that are refractory to standard medical therapy. This report discusses the utility of lumbar sympathetic block (LSB) for the treatment of neurologic symptoms. Methods A review of one patient record who underwent APS-associated livedo racemosa and neuropathic symptoms who underwent a series of lumbar sympathetic blocks. Results A 41-year-old male with SLE and APS presented with progressive bilateral lower extremity numbness, paresthesia, and persistent livedo racemosa refractory to immunosuppressive and supportive therapies. Symptoms were exacerbated by cold exposure and associated with vasomotor instability and functional impairment. The patient underwent serial LSB beginning with unilateral injections followed by bilateral blocks. He experienced improvement in neuropathic symptoms, with reproducible benefit during subsequent flares treated with repeat block series. Cutaneous livedo racemosa persisted despite neurologic improvement. No procedural complications were observed. Discussion This case highlights the overlap between dermatologic vascular disease and neurologic dysfunction in livedo racemosa. The observed response to LSB suggests a role for sympathetic overactivity and microvascular dysregulation in symptom pathogenesis. Sympathetic blockade may improve perfusion and modulate neuropathic signaling, offering a potential adjunctive therapy in refractory cases. Further studies are needed to define its efficacy and mechanisms in this population.