SNEDDON SYNDROME REVEALED BY ISCHEMIC STROKE AND LIVEDO RACEMOSA IN A 69-YEAR-OLD MAN: A CASE REPORT

Background: Sneddon syndrome is a rare, non-inflammatory thrombotic vasculopathy of small- and medium-sized arteries, defined by the association of livedo racemosa and cerebrovascular events. It classically affects young to middle-aged women, which makes recognition in elderly patients particularly challenging and easily overlooked.
Case Presentation: We report the case of a 69-year-old man with a history of hypertension and diabetes, admitted to the neurology department for an acute ischemic stroke presenting as right-sided hemiplegia and aphasia. Physical examination revealed a widespread livedo racemosa of the trunk and lower limbs, which prompted a dermatological evaluation and led to the diagnosis of Sneddon syndrome. Brain computed tomography showed a left fronto cortico-subcortical hypodensity in the territory of the left middle cerebral artery, consistent with a subacute ischemic infarction. The antiphospholipid antibody work-up was negative, defining an antiphospholipid-antibody-negative form of the syndrome. A skin biopsy was not performed, as the eruption was clinically typical of livedo racemosa. The patient was managed with antiplatelet therapy and optimization of vascular risk factors, but his condition deteriorated during hospitalization and he died from cardiogenic shock.
Conclusion: This case highlights that Sneddon syndrome should remain in the differential diagnosis of stroke with cutaneous livedo even in advanced age, and that a simple skin examination can be the key to an otherwise under-recognized cause of stroke