A 58-year-old man presented with a 9-day history of intermittent chest and abdominal pain, which was associated with numbness and tingling of the bilateral upper extremities. The patient had a medical history of atrial fibrillation, for which he was taking apixaban, and psoriatic arthritis, which was being managed with ustekinumab. Physical examination revealed a coalescing lacelike, reticular, violaceous, hyperpigmented rash of the bilateral lower extremities, right abdomen, and right flank with a sharp midline delineation consistent with livedo reticularis (LR) (Figure 1). He had no further focal neurologic deficits, and results of cardiac, pulmonary, and gastrointestinal workup were negative. Punch biopsy of the right thigh revealed no histologic features supportive of vasculitis. LR spontaneously resolved within 48 hours. The patient had no prior history of LR. Thrombotic panels, cryoglobulin level, antiphospholipid antibodies, antinuclear antibody panel, rheumatoid factor level, and angiotensin-converting enzyme testing were unremarkable.