PMC6710843_01
Hands radiogram - osteoarthritic changes with geodes.
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C-reactive protein concentration, with negative rheumatoid factor (RF), negative anti-cyclic citrullinated peptide antibodies (ACPA) and antinuclear antibodies (ANA) titer 1 : 80 (Table I). Comparative hand (Fig. 1) and feet radiograms and spine radiograms showed mainly osteoarthritic changes with multiple geodes.
Legs ulcerations - healing progress. (A) 13.07.2016, (B) 13.10.2016, (C) 27.01.2017, (D) 19.10.2017.
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The examination revealed two extensive ulcerations of lower limbs covering around 2/3 of the right and half of the left calf circumference (Fig. 2A). On admission physical examination revealed extensive deep ulceration of 2/3 of the right calf circumference and two ulcerations on the outer surface of the left calf with dimensions comparable to those during the previous discharge (Fig. 2B), palpable right inguinal lymph nodes, which were confirmed in ultrasound, and large subcutaneous edema, especially of the right limb. In the next few weeks, the healing of the left leg ulcer was complete and the right leg ulcer reduced to superficial and 1/3 of the previous size in a follow-up after several months (Figs. 2C and 2D).