Man With Finger Ulcerations

Abstract

A 49-year-old otherwise healthy man presented to the emergency department with blue discoloration and ulceration of his fingers. He described 6 weeks of waxing and waning painful skin breakdown on his fingertips with intermittent spontaneous drainage. Review of systems was otherwise unremarkable. He endorsed a history of heavy marijuana smoking but no tobacco use. Examination showed pitting of both hands with areas of ulceration on the fingertips (Figure 1). The Allen test for insufficient palmar arterial supply was positive.