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March 1995

Leg Ulcers and Purple Nail Beds

Author Affiliations

University of Utah, Salt Lake City

Arch Dermatol. 1995;131(3):345-346. doi:10.1001/archderm.1995.01690150109023

REPORT OF A CASE  A 73-year-old white woman was referred with nonhealing leg ulcers. Six years before presentation, she noted shoulder pain, dry eyes, dry mouth, and ''hands turning white.'' At that time, she was diagnosed as having rheumatoid arthritis and was intermittently treated with methotrexate and prednisone. Over the past several months, methotrexate therapy was tapered and discontinued. Six weeks before referral, she noted dusky purple leg lesions that became painful and ulcerated. Her medical history was significant for a positive VDRL, for which she reportedly had received a full course of treatment, and a short-term memory deficit of unknown duration.Examination revealed purplish discoloration of the distal third of all finger tips, becoming more intense in the proximal nailbeds (Figure 1). The fingers and toes were cold to the touch and demonstrated decreased capillary refill. Overlying the right lateral maleolus was a 10-cm purulent ulcer with a base

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