case_images: PMC5414616_01
case_images: Erythematous feet (A) and hands (B) at baseline with firm, nodular lesions in the beginning stages of development. An example of extremities (C and D) during a symptom flare with progression of lesions to blisters and ulceration. Demonstration of feet (E) and hands (F) after successful treatment with clonidine and ketamine, and lesions in the process of healing.
case_images: jpr-10-973Fig1.jpg
case_images: PMC5414616_01_jpr-10-973Fig1.jpg
case_images: f1-jpr-10-973
case_images: Her extremities were swollen, erythematous, and mottled (Figure 1A and B), and she episodically developed purple patches on her digits with a characteristic evolution (Figure 1C and D). Clonidine and ketamine were the only agents that transiently dampened her symptoms without provocation of flares; however, she required monthly week-long hospitalizations for these treatments, which provided only minimal relief (Figure 1E and F).