case_images: PMC9978921_01
case_images: Initial presentation of pustular rash on hands and lower extremities approximately 1 year after initiating adalimumab.
case_images: crg-2022-0017-0001-529045_f1.jpg
case_images: PMC9978921_01_crg-2022-0017-0001-529045_f1.jpg
case_images: F1
case_images: About 8 months later, the patient endorsed a new rapidly progressive pustular and painful rash on his bilateral upper and lower extremities (shown in Fig. 1).
case_images: Pathology of skin biopsy sections shows perivascular extravasation of erythrocytes, neutrophils, eosinophils as well as leukocytoclasis (vascular damage) surrounding blood vessels associated with fibrin. These findings are consistent with LCV. H&E stain, x10 magnification.
case_images: crg-2022-0017-0001-529045_f2.jpg
case_images: PMC9978921_01_crg-2022-0017-0001-529045_f2.jpg
case_images: F2
case_images: Skin biopsy of the affected area was obtained, which demonstrated perivascular extravasation of erythrocytes, neutrophils, eosinophils, and leukocytosis surrounding blood vessels associated with fibrin (shown in Fig. 2).
case_images: Improvement in LCV 3 months after cessation of adalimumab and treatment with doxycycline and topical clobetasol.
case_images: crg-2022-0017-0001-529045_f3.jpg
case_images: PMC9978921_01_crg-2022-0017-0001-529045_f3.jpg
case_images: F3
case_images: The patient was treated with topical clobetasol 0.05% and doxycycline 100 mg daily for 3 months with drastic improvement of the rash (shown in Fig. 3).