Various Manifestations of Rheumatic Disorders: Case 3 Rheumatoid Vasculitis

March 2, 2004
David Wolf, MD

Ten weeks before presentation, this55-year-old woman noticed decreasedsensation in her feet and a bluish discolorationof her toes. These symptomsprogressed rapidly, and pain andcoldness in both feet increased in intensity.Her feet subsequently becamegangrenous. Her seropositive arthritishad been diagnosed about 6 yearsearlier. The disease had been wellcontrolled until about 10 weeks beforethis photograph was taken.

Ten weeks before presentation, this55-year-old woman noticed decreasedsensation in her feet and a bluish discolorationof her toes. These symptomsprogressed rapidly, and pain andcoldness in both feet increased in intensity.Her feet subsequently becamegangrenous. Her seropositive arthritishad been diagnosed about 6 yearsearlier. The disease had been wellcontrolled until about 10 weeks beforethis photograph was taken.This image is a particularly gooddepiction of the livedo reticularis patterninvolving the legs. The fishnetappearance of purple discoloration isfrequently an indicator of vasculitis.Rheumatoid vasculitis is a rarecomplication of rheumatoid diseaseand tends to affect patients with along history of rheumatoid arthritisand a high rheumatoid factor titer.Most patients in this group would beexpected to have rheumatoid nodulesas well. Rheumatoid vasculitis mayalso cause hyperkeratotic papulesaround the elbows and knees, nailfold infarcts, deep cutaneous ulcers,and peripheral neuropathy ormononeuritis.

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