Sneddon's syndrome (livedo racemosa and cerebral infarction) presenting psychiatric disturbance and shortening of fingers and toes

A 24-year-old man with livedo racemosa and psychiatric disturbances, manifesting as low intelligence (IQ 80) and delusions, had anti-cardiolipin antibody and showed shortening of the fingers and toes, A skin biopsy of the livedo lesion revealed endoarteritis obliterans, being compatible with Sneddon's syndrome, MRI of the brain demonstrated multiple infarction and moderate cortical atrophy, A single photon emission tomography of the brain showed a marked reduction of the blood how in the front-temporal lobe, These findings might relate to the psychiatric disturbance, After intravenous administration of cyclophosphamide and the start of oral prednisolone, the anti-cardiolipin antibody level decreased and his physical condition improved, However, a low dose of haloperidol is still necessary to maintain his mental condition.