PMC9717430_01
Scattered patchy erythema and pustules on the palms of both hands and the soles (A). The palmoplantar pustules were alleviated after treatment (B).
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And the palmoplantar pustules were alleviated after four weeks (Figure 1).
Skin biopsy pathology of the left hand revealed that the patient suffered from skin hyperkeratosis, with a few focal purulent exudates, epidermal hyperplasia, hypertrophy of the spinous layer and hyperplasia of the epithelium of the epidermis with lymphocytic infiltration.
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Skin biopsy pathology of the left hand revealed that the patient suffered from hyperkeratosis of the skin, with a few focal purulent exudates, epidermal hyperplasia, hypertrophy of the spinous layer, and hyperplasia of the epithelium of the epidermis with lymphocytic infiltration (Figure 2). 
MRI of the thoracic spine shows abnormal signal lesions in the 5th, 8th, 9th, and 10th thoracic spine (T5, T8, T9, and T10).
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Specifically, the cervical and thoracic MRI revealed abnormal signal foci in the 5th, 8th, 9th, and 10th thoracic vertebra (T5, T8, T9, and T10) and some body parts (Figure 3).
PET-CT presented abnormal glucose metabolism with bone alteration in the 1st right sternocostal joint, sternal body, the T5, T8, T9, and T10, and the 4th lumbar vertebra (L4), with a high possibility of a malignant lesion.
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Later, PET-CT was performed, which showed abnormal glucose metabolism with bone alteration in the 1st right sternocostal joint, sternal body, the T5, T8, T9, and T10, and the 4th lumbar vertebra (L4), with a high possibility of malignant lesion (Figure 4).
ECT showed that radiologically distributed thickening appeared in the 1st anterior right rib, right sternoclavicular joint, and right upper tibia (Figure 1F).
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Furthermore, ECT revealed radiologically distributed thickening in the 1st anterior right rib, right sternoclavicular joint, and right upper tibia (Figure 5).   
The patient's vertebral biopsy pathology report did not suggest tumor cells, but only a few broken bones, sequestrums, and bone marrow.
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However, the patient's vertebral biopsy pathology report did not suggest tumor cells; however, it showed T9 and L4 bone tissues with few broken bones, sequestrums, bone marrow, and focal plasma cell hyperplasia (Figure 6).
Pustular lesion on the anterior chest and back.
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The day after the vertebral puncture, the patient developed a folliculitis-like lesion on the anterior chest and back (Figure 7).