case_images: PMC5204063_01
case_images: Marked violaceous erythema and edema of the hands bilaterally, particularly in the areas of the wrists, MCP, and PIP joints during early presentation.
case_images: TORJ-10-122_F1.jpg
case_images: PMC5204063_01_TORJ-10-122_F1.jpg
case_images: F1
case_images: Physical exam was significant for edema of the face and hands, violaceous macules and papules on the palms, erythema over the metacarpophalangeal (MCP) joints, and calcinosis cutis (Figs. 1 and 2).
case_images: Shiny, violaceous erythema and edema and papules of the palmar surface of the left hand during early presentation.
case_images: TORJ-10-122_F2.jpg
case_images: PMC5204063_01_TORJ-10-122_F2.jpg
case_images: F2
case_images: Physical exam was significant for edema of the face and hands, violaceous macules and papules on the palms, erythema over the metacarpophalangeal (MCP) joints, and calcinosis cutis (Figs. 1 and 2).
case_images: Ischemic lesions and ulcerations on the palmar surface in the flexural areas of the PIPs and on the digital pulps of the left hand during early presentation.
case_images: TORJ-10-122_F3.jpg
case_images: PMC5204063_01_TORJ-10-122_F3.jpg
case_images: F3
case_images: Ultimately, his palmar and digital lesions progressed to ischemic lesions in the fingertips (Fig. 3) and small ulcers in the dorsum of his MCP and PIP joints and the soles of both feet.
case_images: Purplish discoloration of the hands, areas of chilblain in the palms, and keratotic changes of the PIPs and DIPs noted at the patient's most recent follow-up appointment.
case_images: TORJ-10-122_F4.jpg
case_images: PMC5204063_01_TORJ-10-122_F4.jpg
case_images: F4
case_images: He otherwise feels well, with the exception of pain in the joints of his hands, as well as purplish discoloration of the hands, areas of chilblain in the palms, and keratotic, fissured changes of the PIPs and DIPs (Fig. 4).