Abstract
A 77-year-old woman from India presented with a rash of 2 months' duration, long-standing neuropathy in a stocking glove distribution, polyarthritis, and fever. The cutaneous eruption consisted of violaceous-to-erythematous patches, nodules, and plaques with associated edema, starting on the bilateral hands and feet and gradually spreading to the proximal limbs, trunk and face (Fig 1, A). The patient had lived in the United States for 2 decades and last visited India 2 years ago. Laboratory tests were remarkable for anti-nuclear antibody positivity, elevated C-reactive protein and erythrocyte sedimentation rate, and slightly decreased complement C3.
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