Livedo reticularis

A 32-year-old woman with a long history of Raynaud's phenomenon presented to the rheumatology clinic for assessment of severe fatigue and a mottled, purplish discolouration of the skin of her lower extremities. In 2014, she was diagnosed with chronic idiopathic dysautonomia, which leads to orthostatic hypotension and postural orthostatic tachycardia syndrome (POTS). Tilt-table testing resulted in a progressive drop in systolic blood pressure by 30–35 mm Hg and diastolic blood pressure by 15–20 mm Hg when tested at a tilt angle of 70 degrees for 18 min. During this test, she also developed progressive sinus tachycardia, with her heart rate increasing from 117 beats per min to 170 beats per min.