PMC5192093_01
A, Generalized bluish and purplish color of the hands with purple papules and nodules observed over the dorsal joints. B, Soft, baggy, and redundant skin with purple nodules coalescing into plaques on the sole of the foot.
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There were symmetric, moderately firm, nontender purple papules on her hands and feet, particularly over the dorsal joints of her hands (Fig 1, A), with some coalescing into plaques on her palms and soles (Fig 1, B).
A, The epidermis is rather normal, with the inflammatory infiltrates consisting of primarily neutrophils. Scattered eosinophils, histiocytes, and lymphocytes are also present. B, Leukocytoclasis, endothelial swelling and focal necrosis are noted. (A and B, Hematoxylin-eosin stain; original magnifications: A, x4; B, x10.)
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Results of 3 biopsies of the right thumb, proximal small finger, and distal small fingers were similar, finding diffuse neutrophilic infiltrates in the skin, subcutis, and synovial tissue (Fig 2, A). Leukocytoclasis, endothelial swelling, and focal necrosis were noted (Fig 2, B).