A previously healthy 30-year-old man presented with a spontaneous onset of a skin ulcer on his left leg and multiple deep-seated necrotic nodules on his extremities (Figure 1). His condition subsequently worsened; he became febrile and developed polyarthralgia, myalgia, and hypoesthesias of his extremities. Laboratory investigations revealed marked anemia, thrombocytopenia, and evidence of hepatic failure. A deep wedge biopsy specimen was obtained from a skin nodule (Figure 2 and Figure 3).
Freiman A, St-Jacques M, Onerheim R, Sasseville D. Fever and Necrotic Nodules on the Extremities—Quiz Case. Arch Dermatol. 2005;141(8):1035-1040. doi:10.1001/archderm.141.8.1035-a