PMC9449881_01
Left upper medial thigh gangrenous ulcer with a central black eschar surrounded by an erythematous halo.
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Physical exam revealed a gangrenous ulcer with a central black eschar surrounded by an erythematous halo, located on the medial aspect of her left upper thigh consistent with ecthyma gangrenosum (Figure 1).
Joint deformities of the hands.
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Rheumatologic examination also revealed deformities in her joints typical of RA, which included z-shaped deformities of both thumbs and ulnar deviation of both hands (Figure 2).
X-ray of the hands showing joint deformities with surrounding osteopenia.
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The X-ray also revealed osteopenia around the metacarpophalangeal joints (Figure 3).