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