A 50-year-old woman with hypertension and chronic renal insufficiency presented with a 6-year history of recurrent episodes of dull, cramping abdominal pain accompanied by intermittent fever and a tender vesicular eruption localized to her palms and soles. Her signs and symptoms recurred approximately every 4 weeks. She also noted a 9-kg weight loss. She was referred to our institution with a presumptive diagnosis of familial Mediterranean fever.
Physical examination revealed a cachectic woman with tender erythematous to violaceous multilocular vesicles with a tendency to a polycyclic configuration in a palmoplantar distribution (Figure 1). Also, there were discrete 3-mm purpuric lesions over the left ankle and the dorsal surface of the left foot. A punch biopsy was performed (Figure 2 and Figure 3).
Papadopoulos EJ, Jaffe ES, Elgart GW, Raffeld M, Turner ML. Periodic Fever With Atypical Dyshidrosis—Quiz Case. Arch Dermatol. 2004;140(4):479-484. doi:10.1001/archderm.140.4.479-a