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Dr. Tessa Cigler (Cancer Center): A 43-year-old woman was admitted to this hospital because of painful nodules on the fingertips, shortness of breath, and fatigue.
Systemic lupus erythematosus (SLE) had been diagnosed 12 years earlier at another hospital. Her symptoms at that time included arthralgias involving the knees and wrists, an ischemic right third toe, and livedo reticularis of her legs. The results of an antinuclear-antibody test was positive, and antiphospholipid antibodies were not detected. A biopsy specimen of the sole of her right foot showed intravascular fibrin thrombi without evidence of vasculitis. She was treated with prednisone, nifedipine, and
Differential Diagnosis
Vasculitis
Thrombotic Vascular Occlusion
Endocarditis
Lymphadenopathy and Pulmonary Nodules
Dr. Karen H. Costenbader's Diagnosis
Pathological Discussion
Dr. Panos Fidias's Diagnosis
Diagnostic Discussion
Discussion of Management
Anatomical Diagnosis
Source Information
From the Department of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital (K.H.C.); the Departments of Medicine (K.H.C., P.F., A.Q.), Radiology (M.D.G.), and Pathology (R.H.T.), Harvard Medical School; the Hematology/ Oncology Unit (P.F.), the Cardiology Division, Cardiac Ultrasound Laboratory (A.Q.), and the Departments of Radiology (M.D.G.) and Pathology (R.H.T.), Massachusetts General Hospital — all in Boston.
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