A 36-year-old white woman presented with a 1-week history of painful nodules on her arms, legs, and hands. For the prior 2 months, she had been under evaluation for a white blood cell count of 11 to 14×109/L and an elevated erythrocyte sedimentation rate of 92 mm/h. The antinuclear antibody, rheumatoid factor, antiphospholipid antibody, cryofibrinogen, cryoglobulin, antistreptolysin antibody, Coxsackievirus, and Parvovirus titers were all normal. Repeated blood cultures yielded no organisms, and a chest x-ray film revealed no abnormalities. An antimicrosomal antibody test demonstrated a titer of 1:100,000 and thyroxine depression. Thyroid replacement therapy was instituted with levothyroxine.
Pak H, Montemarano AD, Berger T. Purpuric Nodules and Macules on the Extremities of a Young Woman. Arch Dermatol. 1998;134(2):231-236. doi: