Case 5-2009 -- A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs

doi:10.1056/NEJMcpc0807822

Volume 360:711-720		February 12, 2009		Number 7

Case 5-2009 — A 47-Year-Old Woman with a Rash and Numbness and Pain in the Legs

Daniela Kroshinsky, M.D., John H. Stone, M.D., M.P.H., Donald B. Bloch, M.D., and Alireza Sepehr, M.D.

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Presentation of Case

Dr. John H. Stone: A 47-year-old woman was seen in the RheumatologyClinic of this hospital because of numbness and pain in thelegs and a rash.

The patient had been well until approximately 2 years earlier,when numbness developed, first on the lateral aspect of theleft leg, ankle, and foot, and then in an identical distributionon the right. Approximately 3 months later, pain developed onthe medial aspect of the left foot, followed by pain in thesame distribution on the right foot. During the next 9 months,the pain spread to involve both lower legs diffusely. . . . [Full Text of this Article]

Differential Diagnosis

Livedo Reticularis

Atrophie Blanche

Xerophthalmia

Mononeuritis Multiplex

Systemic Lupus Erythematosus

Sjögren's Syndrome

Antiphospholipid-Antibody Syndrome

Cutaneous Polyarteritis Nodosa

Livedoid Vasculopathy

Summary

Clinical Diagnosis

Dr. Daniela Kroshinsky's Diagnosis

Pathological Discussion

Discussion of Management

Anatomical Diagnosis

Source Information

From the Departments of Dermatology (D.K.); Rheumatology, Allergy, and Immunology (J.H.S., D.B.B.); and Pathology (A.S.), Massachusetts General Hospital; and the Departments of Dermatology (D.K.), Medicine (J.H.S., D.B.B.), and Pathology (A.S.), Harvard Medical School.