PMC9729983_01
(a) Diffuse hyperpigmentation with hypopigmentation around the chest, nose, and lips of the patient. (b) Ulcerations on patients' fingers. (c) Ulceration on the tip of the patient's fingers.
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Her skin was thickened and hyperpigmented over the face, neck, bilateral arm, forearm, thigh, and leg (Figure 1); there was patchy hypopigmentation over her chest, nose, and lips (Figure 1). The tips of her fingers had punched out ulcerations that were tender to touch (Figure 1).
Axial contrast-enhanced computed tomography scan of chest indicating bilateral pleural effusion and pulmonary edema.
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Supplemental oxygen was started, and an urgent contrast-enhanced computed tomography scan of the chest was done, which showed high-grade pulmonary edema and bilateral pleural effusion (Figure 2).