A 73-year-old man with metastatic carcinosarcoma presented with a 2-day history of a rapidly progressive, painful, erythematous eruption that involved his hands. He had no signs of infection, and none of his medications had recently been changed. Serum complement levels were normal. Physical examination demonstrated approximately 20 tender, well-defined, purple-red nodules, papules, and plaques that measured 1 to 3 cm in diameter and involved the palmar and dorsal aspects of both hands (Figure 1). Also, profound swelling that involved both the joints and the interarticular areas of each digit was present. Lymphadenopathy was not present, and no other skin findings were noted. Punchbiopsy specimens were obtained from the dorsum of the left hand (Figure 2 and Figure 3), and tissue and blood specimens were cultured.
Reichenberg JS, Sagar S, Davis MDP. Painful Purpuric Plaques on Edematous Hands—Quiz Case. Arch Dermatol. 2005;141(11):1457-1462. doi:10.1001/archderm.141.11.1457-d