Various Manifestations of Rheumatic Disorders: Case 3 Rheumatoid Vasculitis

Ten weeks before presentation, this 55-year-old woman noticed decreased sensation in her feet and a bluish discoloration of her toes. These symptoms progressed rapidly, and pain and coldness in both feet increased in intensity. Her feet subsequently became gangrenous. Her seropositive arthritis had been diagnosed about 6 years earlier. The disease had been well controlled until about 10 weeks before this photograph was taken. This image is a particularly good depiction of the livedo reticularis pattern involving the legs. The fishnet appearance of purple discoloration is frequently an indicator of vasculitis. Rheumatoid vasculitis is a rare complication of rheumatoid disease and tends to affect patients with a long history of rheumatoid arthritis and a high rheumatoid factor titer. Most patients in this group would be expected to have rheumatoid nodules as well. Rheumatoid vasculitis may also cause hyperkeratotic papules around the elbows and knees, nail fold infarcts, deep cutaneous ulcers, and peripheral neuropathy or mononeuritis.

(Case and photograph courtesy of Dr David I. Wolf.)